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Location

Longview, TX | United States

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Job description

The Continuum Care Coordinator is a valued member of the hospital leadership team. This role
will work hand-in-hand with multiple departments to improve the lives of patients attributed to
Longview Regional Hospital’s Accountable Care Organization (ACO). The CCC holds responsibility for
managing the Post-Acute Collaborative Network for Longview Regional Hospital and serves as a local
subject-matter expert (SME) on all things ACO. Key responsibilities include, but are not limited to, the
following:
Collaboration with Case Management on appropriate and timely discharges to post-acute
services.
Serve as a liaison between Longview Regional Hospital and the Post-Acute Network.
Participate in readmission reduction efforts
Works closely with the ACO vendor, the Corporate Payment Innovations team, other internal
departments, and Post-Acute Network members to drive performance outcomes in the ACO
attributed population
Regularly updates hospital leadership on ACO performance
Helps to set strategy for the market ACO efforts to drive positive performance
Works closely with both the employed and independent physician participants in the ACO to
identify opportunities for improvement
Provides education and serves a resource for all things ACO in the Longview Regional market
Establishes relationships with community resources to mitigate socioeconomic challenges and
communicates resources back to Case Management, PCPs, and others.
Skills:
Must have a working knowledge of care transitions with specific emphasis on hospital
discharge planning, utilization management, and post-acute resources
Must be an effective communicator and collaborator; comfortable working with multiple
key stakeholders on care delivery efforts
Must be savvy with analytics: ability to aggregate and present data
Must be comfortable presenting information in front of leadership and others
Must be able to perform multiple activities, solve problems, utilize appropriate resources,
make independent decisions, and work well in a team-based environment adhering to
deadlines.
Strong organizational skills a must

Required Education: Bachelors Degree from accredited school/university.
Preferred Education: Masters degree in relevant field preferred.
Required Experience: A minimum of two years of strong clinical/healthcare experience
required. Working knowledge of care transitions with specific emphasis
on hospital discharge planning, utilization management, post-acute

resources, case management and disease management. Understanding
of pre-acute and post-acute venues of care and post-acute community
resources, physician office routines, and transitional procedures for
pre-and post-acute care. Comfortable working with multiple key
stakeholders on care delivery efforts. Ability to aggregate and present
ACO performance data.

Preferred Experience: Supervisory and project leadership experience a plus, knowledge of
Medicare and ACO practice management preferred. Prior experience as
a Care Navigator for high-risk patient populations preferred.

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Job tags

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Salary