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Job Description:
Position Summary: Responsible for providing a variety of Care Coordination activities to support members in navigating physical and behavioral healthcare systems, understanding their benefits and reducing barriers to accessing healthcare services. Care Coordination activities include, but are not limited to, performing comprehensive assessments, creating member-centered care plans, providing episodic and extended programming, monitoring acute facility admissions and discharges, providing condition management education, empowering member’s self-management skills, and referring members to appropriate community resources.
COMPETENCIES/Role-Specific Functions:
COMMUNICATION
Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.
- Communicate clearly and consistently with members related to their healthcare needs, benefits and goals.
- Communicate assessment findings, care plan goals, interventions and outcomes to member and care team in a timely manner.
- Participate in Care Rounds, or similar type meetings, to collaborate with healthcare team to address member needs, care plans and coordination activities.
- Actively engage healthcare providers and staff in identifying high risk members and collaborate with providers and care teams on methods for navigating members’ care successfully along the care continuum.
- Communicate with all internal Physician Health Partners (PHP) departments effectively to result in optimal meeting of business needs.
- Communicates and collaborates appropriately to seek guidance and direction with management when necessary.
PROBLEM SOLVING
Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, understands the difference between critical details and unimportant facts.
- Complete comprehensive assessments to identify needs and barriers to member’s ability to manage their medical conditions and treatment goals.
- Pursue appropriate medical and/or staff interventions in a timely manner to assure problem resolution.
- Provide information and resources to members for crisis management.
- Collaborate with peers, management and other appropriate resources on complicated situations.
- Displays Strength-Based approach to collaborative problem solving.
PRODUCTIVITY
Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, handles information flow.
- Document member information, contacts and interventions in applicable care management software systems utilizing PHP Care Coordination Standard Operating Procedures.
- Actively identifies opportunities to enhance programs and lean processes to improve delivery of Care Coordination services.
- Strategically working with community partners and providers to maximize member outcomes through provider engagement, effective care coordination and collaboration.
- Contribute to the Care Coordination team through staff meeting attendance and participation, lending assistance to co-workers, participation on committees, LEAN events and other relevant PHP activities.
CUSTOMER FOCUS
Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.
- Identifies members, providers, healthcare system partners, state colleagues, and community-based organizations as customers.
- Seek to understand and address processes or barriers that impact a members ability to utilize benefits and/or access services.
- Complete visits with members, their caregivers and significant others in a variety of settings, determined by program models and initiatives.
- Develop and maintain effective professional working relationships with providers, members, caregivers, families and community resources.
- Seek to provide an excellent care coordination experience that is supportive to members mental, physical, social and cultural needs.
- Develop and maintain professional and effective working relationships with all PHP internal customers.
JOB KNOWLEDGE
Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues.
- Ability to build and communicate extensive understanding of network, systems, processes and services available to members.
- Identify members that would potentially benefit from Care Coordination services, by using a variety of data sources, including but not limited to, high risk and utilization reports, prior authorization services, physician/practice referrals, referrals from other sources and practice EMR stratification data.
- Employ motivational interviewing skills to elicit optimal member engagement/outcome.
- Complete required HIPAA training and maintain confidentiality through compliance with regulations and company policy.
- Demonstrates consistently, strong ethics and sound judgement.
- Maintain a core understanding of population management as it specifically relates to high-risk members.
- Utilize behavioral health screening assessments, identify symptoms of behavioral health and substance abuse concerns, and effectively make referrals to appropriate community resources.
- Maintain a working knowledge of community resources to address a wide variety of psychosocial needs members may experience.
- Other duties as assigned.
SELF DEVELOPMENT
Seeks out and accepts feedback, is a proactive learner, takes on tough assignments to improve skills, keeps knowledge and skills up-to-date, turns mistakes into learning opportunities.
- Has ability to receive feedback and apply it to work performance.
- Encourages others on the team surrounding their own self development.
- Demonstrates an understanding of current healthcare trends.
- Fulfills requirements necessary to maintain licensure.
- Identify opportunities for, and participate in, continuing education including workshops, conferences, specific publications, etc.
Qualifications (Education/Experience/Knowledge/Skills/Abilities):
- RN with valid license in good standing. (Required Licensure or Certification for this position must be maintained by the employee as defined by the company policies and procedures)
- Experience working with high-risk, complex members including but not limited to – maternity, DSNP, CSNP, behavioral health, Medicaid – preferred
- Experience of at least a minimum of one year of case management experience or a combination of relevant experience, in the fields of healthcare or behavioral health.
- Experience with 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.
- Accept and work with diverse populations, preferably within the designated region, (age, ethnic groups, socio-economic levels, etc.) and provide culturally sensitive coaching, education and assistance to members and their families.
- Collaborate with community-based resource agencies to effectively manage member’s goals.
- Ability to resolve community resource issues in a creative, positive and timely manner to improve clinical outcomes of members.
- Experience in conflict management and problem resolution.
- Skilled in Motivational Interviewing.
- Skilled in developing and maintaining positive relationships and communicating effectively with internal and external customers.
- Adapt quickly to changing demands in the healthcare industry.
- Coordinate and/or facilitate meetings.
- Perform intermediate level of competence with various computer software applications including MS Outlook, Word, Excel, and Power Point.
- Maintain home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures.
- Maintain Mobile Device for work purposes as defined by the company policies and procedures.
Salary Range:
$63,502.40 – $90,719.20