Program Manager, Care Coordination

Job Summary:

The Program Manager, Care Coordination plays a pivotal role in overseeing the efficient use of resources within the specialty health network, ensuring members receive high quality and cost-effective care. This position will also assist in the implementation of standard Care Coordination processes across the organization. This position will monitor and evaluate referral utilization trends, identify areas for improvement, and collaborate with market leaders to make recommendations. An ideal candidate will have a deep understanding of care coordination and have a demonstrated history of partnering with cross-functional stakeholders to drive projects and business initiatives to completion.

Duties/Responsibilities:

• Participate in developing and implementing standard work for care coordination across the enterprise that includes utilizing tools and resources available for cost effective management.
• Scrub data and prepare analysis and reports to provide meaningful information and resources to market leadership and key stakeholders to outline OU utilization at a provider and care coordinator level, Arista utilization by provider and any other relevant data.
• Assist in implementation and monitoring of Care Coordination and utilization review systems for both referrals within the specialty network and the referral platform.
• Partner cross-functionally to help evaluate and identify solutions to UM-related issues across the enterprise
• Help coordinate efforts to drive effective referral management processes across the enterprise, including collaborating with markets to create and maintain a preferred provider list
• Serve as a liaison with the Optum Utility (OU) team and other external vendors to coordinate efforts for tiering specialists and referral management
• Communicate effectively with local leadership to roll out Care Coordination initiatives and updates
• Audit care coordinator compliance with the OU tool, monitor and evaluate trends, identifying areas for improvement and collaborating with market leaders to advise of recommended action needed
• Evaluate and monitor current process effectiveness and help coordinate pilots and new processes with the enterprise

Required Skills/Abilities:

• Ability to manage and deliver strategic projects, communicate project status and risks to stakeholders
• Strong knowledge of care coordination in a value-based care setting
• Ability to define problems and identify optimal solutions under tight deadlines
• Self-motivated with excellent verbal and written communication skills with all levels of leadership
• Excellent interpersonal and communication skills
• Ability to drive accountability and process changes without direct accountability
• Strong data analysis ability

Minimum Qualifications:

• Associate or bachelor's degree in healthcare administration, healthcare information systems, or related field, preferred
• Minimum of 3 years of experience in healthcare operations, project management, or related field
• Working knowledge of care coordination workflows and processes
• Ability and willingness to travel up to 20% at peak times
• Embodies and serves as a role model of ArchWell Health's Values:
  
  
  
  • Be compassionate
  • Strive for excellence
  • Earn trust
  • Show respect
  • Stay resilient
  • Always do the right thing
  
  
  
  

About ArchWell Health:

At ArchWell Health, we're creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We're passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.