Registered Nurse - Care Coordinator (Community)

Registered Nurse - Care Coordinator (Community)

Care Coordination is defined as the organized coordination of a member's health care services and support activities to improve health outcomes. It involves a team-based approach and includes the member (unless contraindicated), providers, community partners, and other individuals involved in the member's care. Care Coordination focuses on the needs and strengths of the member and addresses interrelated medical, social, cultural, developmental, behavioral, educational, spiritual, and financial needs in order to achieve optimal health and wellness outcomes. Registered Nurse - Care Coordinator is part of an innovative multi-disciplinary care coordination team addressing OHP and CareOregon Advantage members' needs. This position works collaboratively with members who may have complex medical/psychosocial/substance use/abuse issues to identify and achieve individual care plan goals. This role may engage members, providers, and key stakeholders across the care continuum to achieve these goals and meet identified needs. The Care Coordinator works telephonically or in the community to assist the member in meeting their needs.

Estimated Hiring Range:

$102,330.00 - $125,070.00

Bonus Target:

Bonus - SIP Target, 5% Annual

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

Essential Responsibilities

Assessment and Care Planning

• Assess for and identify care coordination needs.
• Evaluate all relevant information in order to determine the needs of the member.
• Identify risk factors and service needs that may impact member outcomes and address appropriately.
• Utilize assessment information to develop individualized care plans for assigned members.
• Coordinate with providers to ensure consideration is given to unique needs in integrated planning and that care plans are timely and effective.
• As able, identify suspected abuse and neglect issues and appropriately report to mandated authorities.
• Implement care coordination plan in collaboration with member, providers, case workers and other relevant parties.
• Work closely and collaborate with physical health, dental health, behavioral health treatment providers, crisis services, Developmental Disability, APD, DHS, etc.

Care Coordination

• Assist members and families to access the care and services they need without barriers.
• Ensure treatment recommendations are understood by the member and provider.
• Assist members through transitions to the next level of care or treatment provider.
• Facilitate communication between members, their support systems other community-based partners and clinical care providers and ensure care plans are shared, as appropriate.
• Effectively coordinate with an interdisciplinary team for integrated care plan support of complex members.
• May participate in a variety of multidisciplinary care team meetings, including participating in CCO/APD IDT meetings to coordinate care services for OHP members in long term care services.
• Collaborate with community providers, state and county case workers, community partners, vendors, agencies, contractors, and other relevant parties.
• Collaborate and coordinate across CareOregon departments.
• Collaborate as appropriate with non-clinical Care Coordination staff involved with the member to support care plan goals.
• Utilize a trauma-informed approach to provide member-centric care and support.
• Assist in helping members move through the continuum of care based on clinical/medical need.
• Make referrals to community partners as appropriate.
• Uses evidence-based approaches to patient education regarding member's health status, disease state, red flag symptoms, symptom management, medication management and self-management strategies.

Transition Assistance

• Assist in transition/discharge planning for members discharging from hospital, acute care settings or those who are transitioning from long term care or other residential facilities to ensure a smooth transition back to community-based supports.
• Collaborates with care managers, multidisciplinary providers, benefit specialists, behavioral health specialists, pharmacists, vendors, and social services to enhance member satisfaction, identify barriers, improve outcomes, and reduce avoidable readmissions.
• Plans, participates in, and facilitates care conferences for medically complex members and others as deemed appropriate.
• Ensure discharge/transition plans are evaluated holistically from physical and behavioral health perspectives.
• Coordinate care for members residing outside of service area as required in contract.

Compliance

• Maintain compliance with all contractual and regulatory requirements Coordinated Care Organization requirements and OAR's.
• Maintain timely and accurate documentation about each member per program policies and procedures.
• Maintain working knowledge of COA and OHP benefits including physical health and behavioral health (RNCC/AI AN will maintain working knowledge of Native American Oregon Health Plan Fee For Service program benefits).
• Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol.
• Maintain strict confidentiality, observing all HIPAA rules and regulations.
• Assist Quality Assurance (QA) staff in identifying health providers with practice patterns which are not in conformity to best practice standards.
• Maintain compliance with the Model of Care requirements if applicable.

Experience and/or Education

Required

• Current unencumbered RN license in the State of Oregon
• Minimum 2 year experience as a Registered Nurse (RN) in the healthcare industry
• Valid driver's license, acceptable driving record and automobile liability coverage or access to an insured vehicle

Preferred

• Bachelor's degree in Nursing
• RN experience in home care, advanced illness, palliative care, hospice, primary care and/or case management
• Experience in mental health and substance use disorder.

Knowledge, Skills and Abilities Required

Knowledge

• Knowledge of the Oregon Health Plan benefit package, eligibility categories, and Oregon Medical Assistance Program (MAP) rules and regulations
• Knowledge of Medicare parts A and B benefit packages and the Centers for Medicare and Medicaid Services (CMS) rules and regulations and community resources
• Knowledge of ICD, CPT, and HCPCS codes
• Knowledge of Addictions and Mental Health services and Programs, drug formularies and basic concepts of managed care
• Knowledge of culturally specific issues, resources, and strengths of the populations served
• Competency in the use of motivational interviewing
• Knowledge of program requirements for Medicare populations and OHP populations

Skills and Abilities

• Ability to understand complex medical and behavioral health diagnostic information to assist providers and other care coordinators
• Ability to organize work and remain focused under stressful conditions with critical attention to detail for accuracy and timeliness
• Ability to collaborate with a variety of professional and technical staff maintaining a customer service orientation and function under potentially tight timelines
• Ability to exercise sound clinical judgment, independent analysis, critical thinking skills, and knowledge of health conditions to determine best outcomes for members
• Ability to establish collaborative relationships, work autonomously and effectively set priorities and work in an environment with diverse individuals and groups
• Ability to effectively lead a multidisciplinary team and manage multiple tasks and remain flexible in a dynamic work environment
• Excellent verbal and written communication and basic word processing skills
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to operate a motor vehicle

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical, ergonomic, and biological hazards.

Equipment: General office equipment

Travel: Requires travel outside of the workplace at least weekly; the employee's personal vehicle may be used. Driving infractions will be monitored in accordance with organizational policy.

Work Location: Hybrid-Community 2 days/week, member facing

If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug