Nurse


Role and Responsibilities

The Care Coordinator (CC) assists with the care coordination of member care of both Utilization and Disease Management/Wellness. Under the direction and supervision of the Care Manager-RN, the Care Coordinator assists members by providing support, education and assistance in the prevention and/or maintenance of their disease and/or health and wellness state; by assisting in supporting member compliance with treatment plans; and by assisting in the collaborative coordination of care to reduce waste and inefficiency. 
 

Core Functions

  • Care Coordinator reports to the management staff and is under the direct supervision of the Care Manager-RN.
  • Provides telephonic follow up with members for Care Management services to include post hospital discharge and chronic condition management.
  • Complete assigned tasks related to care coordination.
  • Generate tasks to the assigned Care Manager-RN
  • As directed and supervised by the Care Manager-RN assist in the attainment of members’ goals by:  working with member, physician, other care providers to meet the member’s individual needs based on protocols and referrals,
    • calling the identified member to offer a review of the Disease Management program,
    • supporting the member education goals regarding their specific chronic condition based on the Plan of Care,
    • informing the member how to access resources
    • assisting in the arrangement of Provider follow-up appointments and delivery of care,
    • mailing of approved educational and informational materials,
    • assisting in the performance of calls to members post discharge from inpatient or other levels of care
    • supporting the monitoring and evaluation of interventions in the Plan of Care.
  • All communications will be conducted in a professional manner.
  • Remains objective in their review and not participate in any way in the delivery of care to the patient
  • Administers tasks as detailed in the member specific Plan of Care.
  • Completes clear and concise documentation in Care Management programs.
  • Participates in weekly Complex Case Review.
  • Assists with handling incoming and outgoing calls: answering questions regarding the referrals and obtaining information as requested by licensed staff.
  • Assists with data entry, faxing, filing and other clerical tasks.
  • Complies with Customer Service expectations as applicable to the Department and Health Plan.
  • Comply with all departmental policies and procedures
  • Participate in departmental and company in-services as appropriate.
  • Recognizes and adheres to the scope / limitations of job requirements.
  • Comply with all departmental policies and procedures. 
  • Participate in departmental and company in-services as appropriate
  • Performs other related duties as assigned.

QUALIFICATIONS AND EDUCATION REQUIREMENTS

  • High school graduate. Some college education preferred in the allied health professional field of study.
  • Healthcare-related experience is preferred.
  • Strong organizational and time management skills, able to work with little supervision while handling numerous projects at once.
  • Excellent written/verbal communication skills, especially the ability to communicate telephonically in a professional and effective manner.
  • Computer literacy in Word, Excel.

SEND US YOUR RESUME