Care Coordinator, RN

Position Summary Responsible for providing a variety of Care Coordination services within the Primary Care (PC) practice setting, for members that are considered at risk and/or who experience barriers to healthcare. Principle Care Coordination services include performing comprehensive assessments, focusing on member-centered care planning, providing episodic and longitudinal care planning, monitoring acute facility stays and discharges, facilitating disease education groups, individual disease education, empowering member’s self-management skills and understanding of their medical condition, and referring members to appropriate community resources. Key Competencies and Role-Specific Functions Communication : Communicates well verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills, and communicates assessment findings, care plan goals, interventions and outcomes to PC providers in a timely manner. Problem Solving : Breaks down problems into smaller components, understands underlying issues, simplifies and processes complex issues, completes comprehensive assessments to identify needs and barriers, pursues appropriate medical and/or staff intervention in a timely manner, provides crisis intervention services, and collaborates with peers, management and other resources on complicated situations. Productivity : Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, documents member information, contacts and interventions in applicable care management software, actively identifies opportunities to enhance lean processes, and contributes to the Care Coordination team through staff meetings, committees, LEAN events and other activities. Self Development : Seeks out and accepts feedback, is a proactive learner, takes on tough assignments, keeps knowledge and skills up-to-date, encourages others on the team, and demonstrates an understanding of current healthcare trends. Customer Focus : Builds customer confidence, commits to increasing customer satisfaction, sets achievable customer expectations, solves customer problems, maintains professional relationships with PC practice providers, members, caregivers, families and community resources, supports practice needs for structured on-site Care Coordination presence, and participates in practice meetings. Job Knowledge : Identifies members that would benefit from Care Coordination services using data sources, completes visits with members and caregivers in various settings, provides crisis intervention, employs motivational interviewing, completes HIPAA training, performs comprehensive assessments, communicates updates to PC physicians, maintains ethics and sound judgment, understands population management, utilizes behavioral health screening, refers to community resources, and performs other duties as assigned. Qualifications RN with valid license in good standing. Minimum of one year of case management experience or a combination of relevant experience in healthcare or behavioral health. Experience working with high-risk DSNP, CSNP, and Medicaid members. Experience assisting patients through transitions on the care continuum. Experience managing psychosocial issues with patients and families. Knowledge of case management, community resources/agencies, program and workflow development, and process improvement. Skilled in Motivational Interviewing. Skilled in conflict management and problem resolution. Skilled in developing and maintaining positive relationships and communicating effectively with internal and external customers. Adapt quickly to changing demands in the healthcare industry. Perform intermediate level of competence with MS Outlook, Word, Excel, and Power Point. A valid unrestricted Texas driver’s license (if applicable) and reliable insured vehicle (if applicable). Home office that is HIPAA compliant for all remote or telecommuting positions (if applicable). Mobile device for work purposes (if applicable). Compensation Salary Range: $63,502.40‑$90,719.20 #J-18808-Ljbffr