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 ne...