Care Coordinator (RN/SW)
Company: Professional Management Enterprises
Location: Indianapolis
Posted on: November 15, 2024
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Job Description:
The Community Well Care Coordinator must oversee the care
coordination, complex case management functions for PathWays to
Aging members who live in the community and who are not receiving
Home and Community Based Services (HCBS) or designated as Nursing
Facility Level of Care (NFLOC). The Care Coordinator must, at a
minimum, be a registered nurse or similar medical professional with
extensive experience in providing care coordination to members 60
years and older. This individual will work directly under the
Health Services Directors to maintain the care coordination
program. The individual will be responsible for overseeing care
coordination teams, care plan development and care plan
implementation. The Care Coordinator will be responsible for
directing the activities of the care coordinators. These
responsibilities extend to physical and behavioral health care
services. This individual will work with the Heath Services
Director, Service Coordinator Administrator, Medical Director,
Provider and Member Services Managers, and with State staff as
necessary, to communicate to providers and members. The Care
Coordinator will provide input, as requested by the State, at
State-level meetings.
Primary Responsibilities:
* Selects, manages, develops, mentors and supports staff in
designated department or region
* Develops clear goals and objectives for performance management
and effectively communicates expectations, and holds the team
accountable for results
* In order to meet the unique needs of our members, have an
intimate understanding of the contractual requirements
* Identify, select, structure, and prioritize process improvement
projects, ultimately implementing changes to meet program
requirements
* Ensures standardized execution of workflow processes, including
conducting performance audits, quality reviews, and compliance
adherence
* Assess, plan and implement care strategies that are
individualized by patient and directed toward the most appropriate,
least restrictive level of care
* Identify and initiate referrals for social service programs;
including financial, psychosocial, community and state supportive
services
* Communicate with all stakeholders the required health-related
information to ensure quality coordinated care and services are
provided expeditiously to all members
* Advocate for patients and families as needed to ensure the
patient's needs and choices are fully represented and supported by
the health care team
* Participates in training and coaching of direct reports as
needed
* Conducts bi-annual field visits with direct reports to observe,
provide areas of teaching, address issues and concerns and foster a
good working relationship
* Collaborates across Optum and UHG and interacted with Medical
Directors, Site Directors, Senior Leaders, Network, Marketing,
Account Management, Quality, Product, and other stakeholders
Required Qualifications:
* Resident of Indiana
* BSN with equivalent experience
* Registered Nurse with an unrestricted License in Indiana
* Experience working within the community health setting in a
health care role
* Experience or knowledge of Indiana Medicaid, Medicare, Long term
care
* Experience coaching or mentoring staff
* Intermediate level of experience with Microsoft Word, with the
ability to navigate a Windows environment
Preferred Qualifications:
* 3+ year of case management leadership experience within a
healthcare industry
* Background in managed care
* Case Management experience
* Certified Case Manager (CCM)
* Experience / exposure with members receiving long term social
supports
* Experience in utilization review, concurrent review and/or risk
management
PME is an equal opportunity employer. We prohibit discrimination
and harassment against any applicant or employee based on any
legally recognized basis, including, but not limited to: veteran
status, uniformed servicemember status, race, color, religion, sex,
sexual orientation, gender identity, age (40 and over), pregnancy,
national origin or ancestry, citizenship status, physical or mental
disability, genetic information (including testing and
characteristics) or any other category protected by federal, state
or local law.
Keywords: Professional Management Enterprises, Lawrence , Care Coordinator (RN/SW), Healthcare , Indianapolis, Indiana
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