Care Coordinator

Job Description: PREMERA. Applying innovation and strategy to create leading-edge health coverage and benefit solutions for our members.

PREMERA's culture promotes individual development, fosters innovation, and rewards success. We are creative, strategic thinkers who use our talents to fulfill our mission of creating peace of mind for our members. First established in 1933, the PREMERA family of health-care companies is headquartered in Washington and serves over 1.5 million members in several Western States. Our unique value proposition is built on a strong local presence and national capabilities.

If you would like to apply your skills and experience to create health-care solutions, consider the following position:
Job Summary:

The purpose of this job is to utilize a collaborative process when following a subscriber. The Care Coordinator will assess, plan, implement, monitor and evaluate the options and services required to meet an individual subscribers health needs, using communication and available resources to promote quality, cost efficient outcomes. The care coordinator helps identify appropriate providers and facilities throughout the subscribers course of illness. The Care Coordinator will ensure that available resources are used in a timely and cost-effective manner in order to promote optimum value for the subscriber and the health plan.

Responsibilities:
1. Perform assessment of individuals health needs.
Collect and assess data.
Conduct case screening.
Interview member and care providers as appropriate.
Determine health and/or psychosocial needs.
Review current status and treatment plan.
Review co morbidities and treatment plan.
Identify barriers to wellness within treatment plan.
Review past history.
Determines implications of resources, availability and limitations of insurance benefits.
Provides education regarding potential health needs and limitations of insurance benefits.
Evaluate environment for accessibility and adaptive needs.
Document findings of member assessment in objective manner.
2. Develop and implement individualized based care management plans when applicable.
Identify and assist in facilitation of services, treatment and funding options when applicable.
Screen identified options to meet needs.
Review treatment plan for consensus and agreement with care providers, physicians, member and support systems as indicated.
Act as advocate for individuals needs as indicated.

Communicate with care providers and attending physicians to insure care plan implementation.
Identifies gaps in treatment and quality issues.
Develop plans including assessments of life care needs and their costs as indicated.
Document ongoing care plan with timelines and responses as applicable.
1. Facilitate, implement, and coordinate health care services.
Facilitate the treatment planning with care providers, physicians, members and support systems.
Review national criteria as indicated.
Communicate with care providers and physicians when rapid changes to clinical picture occur to facilitate safe transition plan.
Communicate regularly with members and support systems.
Understands and implement cost management strategies.
Facilitate efficient and coordinated care.
Determine implications of resources, availability and limitations of coverage.
Document the facilitation, implementation and coordination processes.
3. Monitor and evaluate health care services and outcomes.
Assess benefit value to cost.
Review treatment plans for continuity of care.
Facilitate plan modification as indicated.
Assess individuals compliance with services.
Provide education regarding compliance to member, care providers, support system as indicated.
Review claims for clinical appropriateness, research recurring claims issues and participates in resolution process when applicable.
Document outcomes of monitoring and evaluating health care services for member.
4. Develop and maintain relationship linkages with providers and other internal Premera staff.
Lead and/or participate in cross functional teams for corporate projects related to quality, care management and medical cost containment.
Work with providers for the mutual benefit of PREMERA patients.
5. Participate in the design, evaluation and implementation of comprehensive quality management programs.
6. Maintain continuing education requirements and participate in other on going education/training as

Searchable Keywords: Care Coordinator / gj-mo

Minimum Education Required: Masters

Expected Travel Time: None