HCA, Hospital Corporation of America RN Case Care Coordinator in Glendale, Colorado
The HCA Physician Services Group (PSG) is the physician solution for the Hospital Corporation of America. PSG makes it easier for physicians to practice medicine by reducing the burdens of managing an independent practice and infusing the best clinical and operational standards in every office. With 13,000 employees that work in more than 790 practices across 21 states, PSG is leading the way by delivering high quality, cost effective health care in communities across the country. __
We offer an excellent benefits package, competitive salary and growth opportunities. Join our team and share your skills and talents with the nation's largest private provider of healthcare services.
GENERAL SUMMARY OF DUTIES:The Care Coordinator functions as an integral member of the Quality and Government Programs department to support PSG practices in successfully meeting CMS, ACO and payer quality initiatives in assigned Division(s). Assist Director of Care Coordination in developing structure and processes to aid the assigned Division(s) in successfully meeting quality initiatives.
DUTIES INCLUDE BUT NOT LIMITED TO: * Serve as subject matter expert in quality and value based incentive programs from CMS, ACOs, or payers. * Monitor patient compliance regarding preventative care using Care Vantage and payer reporting. * Access specific portals to obtain data for preparation of reports and prepare reports and other documents to evaluate the progress of quality programs. * Attend CPC learning sessions and share information learned to team members. * Under supervision of Director or Care Coordination Lead, communicate results of CAHPS survey to team in appropriate document. * Maintain patient charting as needed and perform medical record review during HEDIS and MRA projects. * Identify care gaps as defined by quality and value based program metrics through review of payer and program reports, as well as enterprise developed tools (i.e. Care Vantage). Communicate via telephone with patients regarding care needed and document communication appropriately in the electronic medical record. * Schedule appointments related to preventative care and chronic conditions based on identified caregaps. * Work with hospital counterparts following patient discharge. Help facilitate post discharge care coordination based on discharge follow-up recommendations to reduce unnecessary readmissions. * Ability to assist patients with navigation of the provider network and other community based organizations based on their needs. * Assist in submitting necessary documentation for annual PAFs. * Under the supervision of the Director or Care Coordination Lead, assist in the development of tools, education and workflow processes to assist the Division(s) in meeting CMS, ACO, EHR eCQM workflows, coding, and Payer quality initiatives. * Conduct in person and WebEx meetings with practice managers, staff, providers and managers to communicate program goals and provide education. * Maintains comprehensive knowledge of payer and regulatory requirements with ability to work effectively under pressure. Keeps abreast of industry trends and guides team to adapt to meet evolving needs of payers, government programs and the healthcare industry. * Collaborates with interdisciplinary teams and leaders (PSG, SPA, Quality, ACO leaders and care coordinators, and Govt Programs) to achieve the organization’s coordination of care goals, quality goals, and financial performance goals. * Prepares and maintains care coordination reports and prepares periodic reports for senior management, as required. * Prepares and submits minutes from all meetings; as directed. * Maintains awareness of regulations, keeping abreast of pending and or implemented changes and communicates changes to Director of Care Coordinator. * Perform related work and additional duties as requested by supervisor. * Maintains the strictest confidentiality in the areas of patient, employee and physician relations. * Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”.
Qualifications: * Graduate of an accredited college or nursing school as an RN or LPN. * Current licensure as an RN or LPN in state of residence. * Working knowledge of Microsoft Office, PowerPoint, Internet, Adobe, and MS Outlook. * Prefer knowledge of Patient Centered Medical Home (PCMH), CPC , government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payer cost sharing initiatives. * Ability to prepare quality data reports with attention to detail. * Working knowledge of electronic medical records, medical terminology, ICD-10, CPT 11 coding, HEDIS measures, and medical office processes (preferred). * Knowledge of physician office practice operations. * Self-motivated and flexible to the changing needs of the program, team and work environment with the ability to self-direct including prioritization of multiple simultaneous tasks. * Ability to interpret and apply guidelines and procedures and maintain quality control standards. * One (1) year of experience in a physician practice is preferred. INDRR
Job: *Nursing Mgmt & Admin
Title: RN Case Care Coordinator
Location: Colorado-Glendale-Managed Service Organization
Requisition ID: 06464-65291