Care Coordinator Manager

Welcome to Pathways Health Partners, the Accountable Care Organization (ACO) that's leading the charge in helping independent providers transition to Value-Based Care. What We Do: Medicare REACH ACO: We're at the forefront of Medicare innovation. Medicare Advantage MSO: Providing top-notch services to our Medicare Advantage patients. Commercial MSO: Managing care for approximately 16,000 patients across North-West/Central Florida. Where We Operate: From The Villages to St. Petersburg, and across to Mount Dora, we've got you covered! Our Services: Hospital Medicine Group: Delivering exceptional care in hospitals. Affiliated Medical Practices: Managing several top-tier medical practices. Insurance Agency: Offering comprehensive insurance solutions. Join us on our journey to better health and value-based care! Job Summary The Care Coordinator Manager oversees the full Care Coordination Department for Pathways' Accountable Care Organization (ACO) and Management Services Organization (MSO) lines of business, including the Care Coordinator I (patient outreach) and Care Coordinator II (quality) tiers. While monitoring the performance of the entire department, this role is primarily focused on leading the Care Coordinator II team in data-driven quality improvement: reviewing provider office performance, identifying the drivers of avoidable utilization and cost, and directing targeted patient-level action. The role supports Pathways' performance on CMS LEAD Model quality measures for ACO patients and on Medicare Advantage Star Ratings and HEDIS measures for MSO patients, with the goal of improving patient outcomes and care quality while reducing avoidable healthcare costs. For MSO patients, the role also supports Medicare Advantage HMO requirements, including in-network care coordination, payer quality programs, and delegated responsibilities defined in each payer agreement. Role and Responsibilities Position Competencies: Oversee all Care Coordination Department operations across ACO and MSO lines of business, including the Care Coordinator I and Care Coordinator II tiersDirectly supervise the Care Coordinator Lead and Care Coordinator II staff, and review Care Coordinator I performance with the Care Coordinator Lead at least monthlyAssist with monthly provider office performance reviews covering ER visits, hospital admissions, readmissions, Timely Follow-Up, quality care gaps, medication adherence, and cost trendsDirect Care Coordinator II staff in drilling down from office-level trends to patient-level drivers, such as recurring ER users, potentially avoidable visits, missed follow-up appointments, and medication non-adherenceEnsure all patient-level findings are verified against the medical record or source data before action is taken, and that every patient list includes each patient's date of birthOversee performance on CMS LEAD and HMO MA plan quality measuresResponsible for overseeing care coordination workflows and creating new workflows as neededReconcile payer quality care gap lists against internal data and ensure closed quality care gaps are submitted to each payer through supplemental data or CPT II codes, in coordination with MSO CDIS Qualifications/Position Requirements: 1. Education: High School Diploma with subsequent completion of Medical Assistant or Certified Nursing Assistant curriculum required. Associate's or Bachelor's degree in nursing, healthcare administration, public health, or a related field preferred. A combination of education and experience may be accepted in lieu of education 2. Experience: Minimum of 5 years of experience in care coordination, quality improvement, population health, or case management within a healthcare setting, including at least 2 years working with quality measures (ACO, HEDIS, or Medicare Advantage Star Ratings) and utilization data. Previous management or supervisory experience is highly desirable 3. Certification/Licensure: Valid Florida Driver License (unencumbered and no points); Certified Medical Assistant (within six months of hire if not current at time of hire) or CNA; One of the following preferred: Licensed Practical Nurse (LPN), Registered Nurse (RN), Certified Professional in Healthcare Quality (CPHQ), or Bachelor's degree in Healthcare Administration 4. Training and Knowledge Required at Time of Hire: Excellent computer skills with experience in Outlook, MS Office Suite (advanced Excel strongly preferred), EMRs, and population health or care management platforms; Ability to read and interpret claims, utilization, and quality reports; Strong presentation skills, positive and effective communication skills; Good typing skills with quality documentation accuracy Why Work for Pathways? Pathways Health Partners is a growing company based in Leesburg, FL. We are proud of our professional yet family culture with the executive team working daily alongside our team members. We provide competitive salaries, bonuses for all team members, and a benefits package that is second to none. Medical Insurance for Employee and Spouse/Significant Other paid up to 100% by Pathways!Addition of family coverage for dependents at a fraction of the cost25K life insurance for employees 100% paid by Pathways!Increasing Employee coverage or adding spouse/dependents at a fraction of the costVision and Dental Coverage available at a very low cost for employees, spouses, and family401K retirement plan with 100% match up to 4% of annual payPaid holidaysAmple Paid Time Off (PTO) for vacation/sick/personal days We look forward to speaking with you about this opportunity!