Dual Eligible (Special Needs Program) Care Coordinator - RN

US-LA-Peoples Health- New Orleans
Job ID
3523

Overview

Position Purpose 

The Dual Eligible Care Coordinator - RN is responsible for participation in the completion of the initial and annual assessments. and in the development and management of member care plans by reviewing the medical history, utilization patterns, compliance, prescriptions and psychosocial history of the plan members.  The Dual Eligible Care Care Coordinator - RN also offers expertise in ongoing counseling and follow-up of members who quality for case management.

 

Scope of Position

The Dual Eligible Care Coordinator - Rn is a member of the interdisciplinary care team (ICT), ensures that the dual-eligible member has an individualized care plan (ICP); that the ICP is reviewed and approved by the ICT per policies and procedures and updates the plan as needed for changes in status. The Dual Eligible Care Coordinator-RN reviews the Peoples Health databases to ensure that assessments and ICPs document problems, develop measurable goals, and interventions for all issues identified in the health risk assessment (HRA). The Dual Eligible Care Coordinator-RN will assist in preparation of ICT meeting agenda(s) and follow-up to referrals from the ICT. The Dual Eligible RN Care Coordinator will also have responsibilities to maintain and ensure alignment with the mission of Peoples Health as outlined in the Mission Statement.

Responsibilities

Principal Responsibilities

 

As part of a multidisciplinary care coordination team, the principal responsibilities are:

 

  1. Understands and adheres to the process and documentation requirements of all SNP and Medical Management policies related to the care of the special needs population.
  2. Contacts members as they are scheduled to complete the initial and annual assessments (health risk assessment), as well as completes assessments required as a result of a change in the member’s health status.
  3. Researches, reviews and documents in the member record of the Peoples Health clinical documentation systems.
  4. Creates an individualized care plan (ICP) for each member
  5. Develops measurable goals for issues identified in the health risk assessment (HRA).
  6. Uses clinical knowledge to assimilate information from multiple sources to develop an accurate picture of the member’s condition in order to identify needs.
  7. Communicates with member to assist with development of health goals and identify interventions to achieve these goals.
  8. Provides education to members to address needs identified in the assessment and promote adherence to the ICP.
  9. Participates in the coordination of the ICP review for ICT meetings.
  10. Serves as a member of the SNP ICT; providing reports on the results of member assessments, and making recommendations for care needs.
  11. Develops the member’s care plan in Peoples Health clinical documentation systems (CCMS and MACESS).
  12. Prepares and generates referrals to the appropriate disciplines in order to provide education, services, and/or programs to address member needs.
  13. Conducts follow-up on members as directed by ICT.
  14. Promotes a professional, positive image of Peoples Health throughout the community. Identifies and communicates community and Peoples Health departmental concerns to the appropriate department.
  15. Maintains knowledge of community resources for members.
  16. Maintains knowledge and understanding of Peoples Health member benefits for the Special Needs Plan.

Peoples Health Competencies

Every employee is expected to meet Peoples Health minimum requirements:

  • Commitment: to our Members: We have the power to change our members lives by placing them at the center of everything we do, everyday.
  • Action: By working together and delivering quality service, we enhance the lives of our members through dedication and teamwork.
  • Responsibility: To continue to strive to be the best for our members by adapting and evolving to change, continuing professional development, and to never stop learning.
  • Excellence: By exceeding expectations and finding innovative ways to exceed standards, we are changing our members’ lives.

 

Additional Competencies

  • Professionalism
  • Prompt and dependable
  • Ability to assess clinical data and draw conclusions
  • Communication skills (read, comprehend written and oral communications at a college level)
  • Ability to comprehend and adhere to policies and procedures
  • Ability to work under pressure and organize work to meet deadlines
  • Ability to interview, assess, and communicate effectively with members with carrying levels of education.
  • Planning and organizational skills
  • Creative, innovative and strategic thinker
  • Negotiation; conflict management and resolution skills
  • Manages time appropriately, efficiently, and effectively
  • Collaborates and is a team worker
  • Effective problem solving and decision making skills
  • Effective listener
  • Ability to effectively interact with multifaceted medical and professional staff.
  • Maintains pleasant and helpful attitude; willingness to adapt to change.

Qualifications

Experience/Education

  • Required-
    • Diploma or degree in nursing
    • 3-5 years’ experience in clinical or similar setting
    • Experience with clinical documentation systems
    • Experience in assessing patients and developing care plans
    • Strong organizational skills, attention to detail, verbal and written communication skills
  • Preferred
    • Bachelors in Nursing
    • Experienced in management care industry
    • Understanding of HMO and third-party administration
    • Understanding of nursing home and long term acute care regulations preferred.
    • Continuing education in the healthcare/managed care industry
    • Ability to operate standard office equipment, computer, printer, fax and copier.

 

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