Care Coordinator III

0100 PHP Administrative; United States; On-site; USD 43,000 - 74,000; Full time

Benefits offered by this job

Tuition reimbursement

Staff safety badge

Shift differentials (night/weekend)

Malpractice insurance

Loan forgiveness

EPIC system access

Job summary

Presbyterian Healthcare Services is seeking a Care Coordinator III to support health plan members and coordinate interdisciplinary care across the continuum. You will assess needs, prepare and authorize services, and serve as a primary contact for care coordination, ensuring timely and appropriate interventions.

The role emphasizes collaborating with care teams, documenting plans, and advancing cost-effective, high-quality outcomes within a mission-driven healthcare system in New Mexico.

Qualifications

• Masters degree with 2 years of experience, or Bachelor’s with 4 years, or Associate with 5 years; 10 years may substitute.
• We follow Care Coordination Standards and promote patient-centered care across care settings.

Responsibilities

• Supports Health plan members and facilitates interdisciplinary team care to ensure quality, cost-effective services.
• Develops and communicates plans for authorization of services and acts as the point of contact for care coordination.
• Performs ongoing plan reviews to identify gaps and improve health outcomes; monitors interventions and adjusts plans as needed.
• Educates providers and staff on care coordination roles and strategies to improve member experience.

Skills

Care coordination

Interdisciplinary teamwork

Healthcare regulations

Patient advocacy

Education

Masters degree

Bachelor's degree

Associate degree

10 years experience acceptable

Tools

EPIC electronic charting

Job description

Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237 Compensation Pay Range: Minimum Offer $31.50 Maximum Offer $53.66 Summary: Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes How you grow, learn and thrive matters here.

• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system

Responsibilities

• Supports Health plan members
• Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services.
• Provides care coordination to members with chronic condition with less complex needs including less community resources. Conducts in depth health risk assessment and/or comprehensive needs assessment which include but not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. Develops and communicates plan for authorization of services, and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services).
• Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes; collects clinical path variance data that indicates potential areas for improvement of case and services provided; works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
• Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for member s care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan.
• Provides assistance to members with questions and concerns regarding care, providers or delivery system.
• Conducts face to face home visits, as required.
• Educates providers, support staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost effective delivery to quality care and services.
• Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
• Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Generates reports in accordance with care coordination goals.
• Complies with Case Management Society of America Standards for Case Management Practice and with CCMC code of Professional Conduct for Case Managers.
• Participates in Interdisciplinary Care Team (ICPT) meetings.
• Assists with orientation and mentoring of new team members as appropriate.

CARE COORDINATOR III-11466

• Performs other functions as required.

Qualifications

Masters Degree & 2 years exp, Bachelors degree & 4 years exp, Associates degree & 5 years exp, 10 years of exp may be utilized in lieu of other education & exp reqs.

We're all about well-being, starting with yours. Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED.

PHS is a drug-free and tobacco-free employer with smoke free campuses.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services Here, we’re committed to a different way to make a difference.

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three New Mexicans.

We are part of New Mexico's history and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.