The Wellvana Care Coordination Coordinator is an essential
support role to the internal care management staff as well as to
patients and our participating providers. The perfect Care Manager
applicant will recognize and identify with these core values:
This position will report to the Care Coordination Coordinator
in Las Cruces, NM and will be working from Las Cruces Clinics
within the Wellvana network, and telephonically to support other
The Care Coordination Coordinator is a patient and family
advocate to ensure that services are delivered to meet the needs of
patients and families while being a responsible steward of
The Wellvana Care Coordination Coordinator will support the
patient through complex healthcare environments for the
optimization of care and outcomes. They will facilitate patient
follow-up through coaching, information transfer, and communication
in order to improve continuity of care and streamline the
intervention process. The incumbent guides patients through the
health care system by assisting with access issues, developing
relationships with service providers, and tracking interventions
and outcomes. They serve as a point of contact for referring
physicians, patients, and rural hospitals to provide resources and
assistance with accessing clinical and supportive care services.
This role will require collaboration with local physician liaisons
and leadership to conduct internal and external outreach and
The Wellvana Care Coordination Coordinator will:
Support the patient through complex healthcare environments for
the optimization of care and outcomes.
Facilitate patient follow-up through coaching, information
transfer, and communication in order to improve continuity of care
and streamline the intervention process.
Guides patients through the health care system by assisting with
access issues, developing relationships with service providers, and
tracking interventions and outcomes.
Serves as a point of contact for referring physicians, patients
and rural hospitals to provide resources and assistance with
accessing clinical and supportive care services.
Day to Day responsibilities:
- Monitor practice AWV statuses and open care gaps and
effectively communicate with clinic staff.
- Review daily ADT feeds from the health information exchange and
identify patients that would benefit from TCM services.
- Identify and engage patients that would benefit from increased
care coordination between primary and specialist care.
- Assist with referral coordination.
- Assist office staff with scheduling routine visits.
- Coordinate and Educate Patients and providers on preventative
care programs and communicate / upload statistics.
- Work closely with all Wellvana hospitalists to ensure patients
are discharged to the appropriate level of care.
- Work directly with Wellvana Preferred Supplier Facilities to
ensure pre-determined protocols are followed.
- Maintains oversight to active inpatient census to effectively
communicate about and identify patients with high risk and rising
risk conditions to the physician or appropriate leadership.
- Initiate TCM after inpatient hospital stay according to CMS
Additional Duties and Responsibilities:
- Assist and support Care Coordination Management staff in all
preventative care programs with a focus on key groups and
- Works with the physician, hospital team, clinic team,
patient/family, and Director of Clinical Programs to ensure timely,
appropriate and cost-effective care is provided within supportive
- Acts as a liaison between the patient and physician or patient
and clinic or post-acute facility when needed.
- Understands that this is a developing role and will perform
additional duties as assigned.
Skills and Abilities Required:
- Experience as an acute care case manager with associated
working knowledge of the discharge process
- Proven success in case management and care coordination, within
acute and post-acute settings.
- Knowledge of EMR and healthcare-related patient quality
monitoring and reporting technology.
- Knowledge of insurance reimbursement and pre-authorization
requirements across all potential payors, to ensure proper
placement of patients.
- Excellent communication skills, both written and verbal.
- Proven critical thinking skills.
- Effective problem solving.
- Able to work independently or as a team.
Education / Experience Required:
- Current licensure as an LPN/LVN or RN
- 3-5 years experience in a healthcare setting specifically
designed to develop and improve patient navigation and placement
within the proper care setting with proven success in the local
- Certification or industry recognized experience consistent with
the high-level performance and knowledge across disparate
facilities and providers in the local market.