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Serves as part of a multi-disciplinary team to support patients by assessing individual risk factors, developing comprehensive care management plans, encouraging preventive care services, and following targeted evidence based clinical protocols to optimize clinical utilization management and care outcomes for patients and their families.
About Orlando Health Medical Group Orlando Health Medical Group is a comprehensive physician group serving patients from across the southeastern United States. With more than 200 practices and 1,200 physicians, Orlando Health Medical Group has a strong representation in over 55 specialties, including cardiology, vascular medicine, orthopedics, oncology, digestive health, neurology, neurosurgery, bariatric surgery, general surgery, bone marrow transplant and critical care medicine, as well as more than 30 pediatric subspecialties, women’s health, primary care and the largest hospitalist program in Florida.
Orlando Health Medical Group is part of the Orlando Health system of care, which includes award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities that span Florida’s east to west coasts and beyond. Collectively, our 27,000+ team members honor our over 100-year legacy by providing professional and compassionate care to the patients, families and communities we serve.
Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. “Orlando Health Is Your Best Place to Work” is not just something we say, it’s our promise to you.
Orlando Health Offers Great NEW Competitive Pay and Great Benefits Package that Includes: Medical, Dental, Vision 403(b) Retirement Savings Plan Health Savings Account (HSA) Flexible Spending Account (FSA) Paid Time Off (up to 5 weeks to start) Life Insurance Extended Leave Plan (ELP) Family Care (childcare, elder care, pet care) Paid Parental Leave Pet Insurance Car Insurance Educational Benefits including tuition reimbursement & monthly payments to help pay down any graduated school debt Job Summary Directly responsible for providing high quality clinical care management services collaboration with clinical and administrative stakeholders.
Serves as part of a multi-disciplinary team to support patients by assessing individual risk factors, developing comprehensive care management plans, encouraging preventive care services, and following targeted evidence based clinical protocols to optimize clinical utilization management and care outcomes for patients and their families. Responsibilities
Possesses a strong understanding of medical terminology and understands healthcare operations, patient engagement, physician relations and all other healthcare related issues. Takes initiative to develop knowledge, skills, and abilities to perform at a high level in the care transition navigation role, including staying abreast of related care transition management news, documentation, and literature. Ensures compliance with all necessary risk management programs, corporate quality initiatives, and other corporate objectives.
Partners with various healthcare entities and physician practices to foster integrated relationships with patients, families, and caregivers to facilitate streamlined patient transitions across the continuum of care. Assists patients and caregivers in navigating care services post-hospitalization, including development of patient-tailored post-acute care plans and routine patient monitoring to ensure plan adherence.
Engages with patients using strong communication skills and utilizes patient feedback to identify current service needs and anticipate future service needs using a patient-first philosophy. Distributes approved educational materials and other care transition resources to patients and caregivers to effectively remove social determinants of health barriers with the goal of preventing readmissions and other avoidable care events.
Advocates for patient needs by proactively identifying barriers to treatment plans and ensuring patients have access to needed prescriptions, durable medical equipment, and other care services, as necessary. Maintains a high level of proficiency with organizational informational systems, including ELLiE Healthy Planet modules, to ensure care transition support for our covered populations is efficient, timely, and effective.
Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards. Maintains compliance with all Orlando Health policies and procedures. Works comfortably in teams as a participant and facilitator, including temporary teams for project-based initiatives.
Possesses the ability to prioritize and work independently in addition to being an integral part of the care team. Documents work efforts in an organized and accessible fashion while respecting confidentiality/privacy standards. Contributes to environment of psychological safety where ideas are welcomed, considered, and appreciated.
Qualifications Qualifications High school diploma or GED required. One (1) year experience as a Medical Assistant, Paramedic, Emergency Medical Technician, Military Allied Health Professional, Nursing Assistant or related health care role in value-based care or physician offices required. None.