Clinical Care Coordinator - New Castle County, Delaware

📋 Description

• • As a Clinical Care Coordinator at Highmark Health, you will play a pivotal role in enhancing the quality of care and managing costs for members with chronic conditions and gaps in care. This dynamic position involves direct engagement with members and healthcare providers across various settings, including physician offices, hospitals, and potentially the member's home, to assess needs and coordinate comprehensive care plans.
• • Your primary responsibility will be to conduct member-facing clinical assessments, leveraging advanced clinical knowledge and motivational interviewing techniques. The goal is to empower members to improve their self-management skills and adopt positive behavior changes, leading to increased member satisfaction and optimized healthcare costs.
• • You will act as a subject matter expert, providing essential education, consultation, and training to both internal teams and external stakeholders such as healthcare providers, regulatory agencies, and utilization management departments.
• • A key aspect of this role is serving as a trusted resource, guiding and mentoring colleagues on understanding the drivers of healthcare costs and implementing strategies to improve member outcomes through effective utilization of Plan benefits and resources.
• • In complex clinical scenarios requiring sophisticated intervention, you will collaborate closely with treating providers, coordinating and communicating essential clinical and psychosocial information to ensure seamless care delivery.
• • You will be instrumental in developing and implementing tailored care plans or intervention strategies for specific conditions or cases. These plans will be designed to establish clear short-term and long-term goals and may be integrated into the member's Electronic Medical Record (EMR) or medical record for continuity.
• • Establishing a consistent plan for regular member and/or provider contact is crucial. This includes face-to-face interactions whenever feasible, to monitor progress towards established goals, deliver ongoing education, and evaluate the necessity of plan modifications.
• • Proactively integrating opportunities for lifestyle improvements and preventive care into all member interactions and coaching sessions will be a core function of your role.
• • You will collaborate with relevant individuals and teams to identify and implement solutions for refining existing practices and enhancing operational performance. Participation in developing performance improvement processes is essential to elevate member outcomes and support strategic initiatives, including Health Care Reform and STARS initiatives.
• • A significant part of your work will involve engaging with providers to discuss performance measures and activities, with the aim of educating and influencing the behavior of both members and providers towards better health outcomes.
• • Ensuring meticulous documentation of all activities and strict adherence to applicable business process requirements, regulatory mandates, and accreditation standards across all lines of business is paramount.
• • This role offers the opportunity to make a tangible impact on member health and well-being while contributing to Highmark Health's mission of delivering exceptional healthcare services. You will be empowered to work with a degree of autonomy, driving initiatives and fostering positive relationships within the healthcare ecosystem.
• • The position requires adaptability and the ability to navigate a fast-paced, high-visibility environment, working effectively within a high-performing team. Flexibility in work hours and location, including travel to various work sites, is expected to meet the needs of members and providers.
• • You will be expected to contribute to a culture of continuous improvement, sharing insights and best practices to elevate the standard of care coordination and member support.
• • This role is ideal for a proactive, self-directed individual with strong organizational and time management skills, capable of managing multiple priorities and delivering results in a dynamic healthcare landscape.