MSHO/MSC+ Care Coordinator

HealthPartners is hiring an MSHO/MSC+ Care Coordinator. This position exists to provide support to patients, their families, and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.

ACCOUNTABILITIES:

• Member Focus
  • Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs.
  • Identifies interventions and resources to assist member reaching personal health related goals.
  • Identifies patterns and episodes of care that are predictive of future needs and services.
• Integration
  • Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.
  • Facilitates integration of patient care by encouragement of effective communications between patients, families, providers, health plan and care system programs, and community-based services.
  • Adheres to department policy and procedure in daily activities.
  • Coordinates service coverage with appropriate funding sources when indicated.
  • Works with Supervisor, Case Management, Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations.
• Communication
  • Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system.
  • Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.
  • Provides educational information and materials to members to support preference sensitive decisions.
  • Provides regular reporting of member outcomes to Case Management leadership according to defined process.
  • Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure.
  • Identifies and promptly reports high cost cases for reinsurance.
  • Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure.
  • Maintains confidentiality of information in accordance with department and corporate policies.
• Relationships and Team Building
  • Establishes and maintains good working relationships within the Comprehensive Care Advocacy department, with other HealthPartners departments, and with other health team participants.
  • Supports other team members in achieving patient centered goals.
  • Assists supervisor in maintaining a cohesive Case Management team by contributing to a collaborative, respectful, and diverse environment.
  • Participates in and contributes to appropriate departmental and/or organizational meetings.
• Technology
  • Maintains knowledge of and effectively uses automated applications and systems.
  • Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.
  • Maintains maximum individual productivity through proficient use of automated systems.
• Personal Development
  • Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management, patient care services, and benefit packages for development of effective case management skills.
  • Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
  • Maintains current, active Minnesota nursing or social work licensure.
  • May maintain current, active nursing or social work licensure in other states as assigned.
• Other Duties
  • Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.
  • Performs other duties as assigned.

CURRENT DIMENSION:

• Directly reports to Supervisor, Case Management.
• Directly manages caseload with anticipation of up to 85 members with complex needs.
• Interacts with medical, administrative, and front line staff within and outside the organization in order to collaborate on members care.
  

REQUIRED QUALIFICATIONS:

• Social Worker or Registered Nurse considered RN with BSN preferred, must have current unrestricted license in the State of Minnesota. License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure
• Minimum of 2 years of home and community based experience; experience with relevant utilization review, discharge planning, or case management experience; and current clinical knowledge
• Demonstrated effective, independent professional judgment and skills
• Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication
• Demonstrated working knowledge of quality improvement, utilization management, MSHO/MSC+ plans, fiscal management. Understanding of healthcare and/or MCO industry
• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations
• MnCHOICES Assessor Certification in place or within 3 months of hire date
• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.
• Basic computer skills

CHALLENGES:

• Maintaining member focus in a rapidly evolving environment.
• Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the Case Management Program.
• Contributing a positive team building approach as a member of the Case Management team, and a global member of the Case Management Department.

DECISION-MAKING:

• Makes independent decisions within the scope of this position’s accountabilities and determines the need for and the timing of consultation with Case Management leadership and/or Medical Director.
• Uses professional clinical judgment, organizational knowledge, industry knowledge, and common sense in determining appropriate alternatives for members/patients/families, consulting with leadership and/or Medical Director, when indicated.
• Makes recommendations to leadership regarding policy development needs and/or changes.