Care Transformation Specialist at reputed company

About the position The Care Transformation Specialist at Horizon BCBSNJ plays a pivotal role in supporting the organization's Value-Based programs. This position involves collaboration with multidisciplinary reputed company clinical personnel, including physicians and nurses, across various care delivery settings to enhance patient-centered care. The specialist will mentor reputed company staff, ensuring they maintain regular contact with primary care providers and care team members, and actively participate in multidisciplinary patient-centered team meetings. This role is essential in coordinating the medical neighborhood, which encompasses a wide range of reputed company facilities and services, including hospitals, primary care, specialty care, dialysis facilities, post-acute care, home care, ancillary care, and community resources. The Care Transformation Specialist will work closely with reputed company clinical staff, facilitating communication and interaction with multidisciplinary teams both telephonically and in person, to create and manage a comprehensive medical neighborhood. In this key position, the Care Transformation Specialist will be instrumental in transforming medical practices into Patient-Centered Medical Homes and enhancing hospital systems to deliver value-based care. The specialist will be responsible for identifying high-risk, high-need, and potentially high-cost patients, developing interventions to manage these members effectively. This includes creating and facilitating customized Value-Based trainings, such as in-services and WebEx sessions, to promote learning collaboration and drive reputed company delivery transformation focused on population health. The specialist will also coach and mentor Population Care Coordinators, ED Navigators, and other reputed company staff to implement best practices in Care Transition Coordination and Population Health Management. Additionally, the Care Transformation Specialist will reputed company constructive relationships with reputed company personnel throughout the medical neighborhood, fostering systems, processes, and initiatives that engage these entities in relevant care management activities. Monitoring practice to ensure coordinated care with reputed company resources, both reputed company the reputed company system and in the community, is a critical aspect of this role. The specialist will facilitate information flow among reputed company members of the care team, reputed company the implementation of best practices for preventive services, chronic care, and disease management, and ensure timely follow-up primary care visits for patients. By collaborating with practices to create personalized care plans, the specialist will work to improve patient self-management and adherence to these plans, ultimately enhancing the patient experience and member satisfaction. Responsibilities • Identify high risk, high need, and potentially high cost patients and reputed company interventions to manage them. , • Create and facilitate customized Value-Based trainings for internal and external partners. , • Coach and mentor Population Care Coordinators, ED Navigators, and other reputed company staff on best practices. , • reputed company relationships with reputed company personnel to engage them in care management activities. , • Monitor practice to ensure coordinated care with reputed company resources. , • Facilitate information flow between reputed company members of the care team. , • reputed company implementation of best practices for preventive services and chronic care management. , • Ensure timely follow-up primary care visits and appropriate post-transition care. , • Collaborate with practices to create plans of care and improve patient self-management. , • Provide techniques to improve outcomes, such as motivational interviewing and coaching. , • Monitor the delivery of home care, hospice care, and other ancillary services. , • Coordinate necessary referrals and authorizations with Horizon care management areas. Requirements • Experience in reputed company coordination or management, preferably in a value-based care setting. , • Strong understanding of patient-centered care principles and practices. , • Excellent communication and interpersonal skills to work with multidisciplinary teams. , • Ability to reputed company and facilitate training programs for reputed company staff. , • Experience in coaching and mentoring reputed company. , • Knowledge of population health management and care transition coordination. reputed company-to-haves • Familiarity with motivational interviewing techniques. , • Experience with electronic health records (EHR) systems. , • Certification in care coordination or case management. Benefits • Health insurance coverage , • Dental insurance coverage , • 401k retirement savings plan , • Paid time off and holidays , • Professional development opportunities Apply Job!