Nurse Care Coordinator Job at Clear Spring Health
OPPORTUNITIES AVAILABLE IN ANY STATE WITHIN THE U.S.
Job Summary:
Performs all functions delineated in the CSH Care Management Program description, including activities and projects in support of Quality Improvement.
Main Accountabilities:
- Serves as Member advocate, assessing and assuring quality care is given.
- Identifies high risk factors, barriers to goals, and strengths that will assist the Member in achieving goals.
- Assists the Member in managing their health conditions, prioritizing their health care needs, and preventing complications.
- Coordinates care in conjunction with multidisciplinary healthcare team, the Member, and other providers.
- Provides timely reviews of the care plan with the Member as necessary, re-evaluates and modifies the plan of care based on Member outcomes.
- Regularly communicates with the Member to maximize care opportunities.
- Provides self-management support to the Member and refers to other resources as appropriate.
- Provides necessary and appropriate education materials to the Member.
- Conducts telephonic and other outreach to the Member before, during, and after specific healthcare interventions, in order to facilitate services and/or follow-up care.
- Provides and ensures accurate clinical documentation in the care management system.
- Promotes effective and efficient utilization of clinical resources and services.
- Establishes and maintains collaborative relationships with internal team members and external providers.
- Partners with team in the evaluation and support of quality initiatives (HEDIS and STARS).
- Promotes team environment.
- Other tasks and duties as assigned.
Qualifications:
- Licensed Registered Nurse.
- NLC license or Licensed in Georgia AND South Carolina
- 1-3 years Managed Care experience in Care Management.
- Working knowledge of Medicare Advantage plans.
- Bilingual strongly preferred.
- CCM certification strongly preferred.
- Strong analytical skills.
- Strong computer skills – Microsoft Office Suite.
- Strong communication and interpersonal skills.
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