Registered Nurse - Care Coordinator, Quality Management

Position Summary :

Functions as a liaison that collaboratively works with patients, physician and referral sources in the community to manage and improve the health conditions of each patient by educating the patient / families and coordinating additional services needed.

The RN Care Coordinator works in collaboration with and provides guidance to the Care Management Team members and under the direction of Quality Leadership to provide collaborative care management services.

Responsibilities

• Provides guidance and supervision for the Care Navigators to ensure a collaborative approach to care management services.
• Responsible for carrying out key functions related to patient outreach, quality reporting, performance measurement, and acting as a key liaison between physician and patient.
• Performs outreach functions, as necessary, to patients that have been identified as having chronic conditions that meet eligibility requirements for their program.
• Assesses, identifies and prioritizes individual needs and builds rapport and trust with patients.
• Reviews and assesses the member’s available data, including clinical history, outpatient / inpatient treatments, emergency room visits, medications, chart reviews, or other information, to assist in monitoring and facilitation of adherence to prescribed care plans.
• Collaborates with the patient and provider regarding opportunities for optimizing care and closing gaps.
• Facilitates patient understanding of the physician’s treatment plan, including but not limited to, prescriptions, prescription refills, medical supplies, referrals, authorization of services, and when to seek care.
• Performs assessment of the patient and / or family to further assess social, emotional, functional and physical health status.
• Promotes education by supplying informational materials, directing the patient to the appropriate agencies and facilities in the community for care.
• Responsible for understanding, assisting, educating, and facilitating the overall plan of care of patients with chronic conditions.
• Serves as a liaison between practice and insurance payors concerning the care and treatment options of certain patients with chronic health conditions.
• Responsible for understanding, assisting, educating and facilitating the maintenance and promotion of preventative care of a chronic patient including promotion of preventative screenings, lifestyle coaching, and on-going follow up care.
• Provides education to providers, office managers and other clinic staff relating to quality initiatives and clinical documentation improvement.
• Maintains continuity of care among care coordination team members by documenting and communicating actions, opportunities and continuing needs.
• Assures evidence-based practice guidelines are incorporated in to patient’s plan of care.
• Assists in the coordination of transitions in care for designated patient populations.
• Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care initiatives.
• Ensures effective communication with payer care coordination team to collaborate on patient care initiatives and care management strategies.
• Provides effective strategies to decrease unnecessary emergency room utilization and hospital readmissions.
• Reviews and analyzes available quality data to prioritize patient goals and develop care management strategies for appropriate patient populations.
• Demonstrates knowledge of payer contracts including required quality metrics and available payer resources to assist in care coordination efforts.
• Demonstrates knowledge of HEDIS, HCC’s and Medicare Risk Adjustment and their impact on pay-per-performance contracts.
• Perform other duties as assigned or requested.

Qualifications

Minimum Education :

None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and / or certification as required by the issuing authority.

Minimum Experience :

Three to five (3-5) years experience in a clinical setting, case management experience preferred. Must be computer literate with basic knowledge of Microsoft Office programs.

Ability to build rapport and engage patients in effective dialogue related to their treatment plan. Ability to quickly identify and prioritize patient’s needs and provide structured and focused support and interventions.

Exceptional level of critical thinking, analytical and creative problem solving skills. Exceptional level of independence, organization and interpersonal skills.

Strong communication skills required. Care coordination or case management experience preferred, not required.

Licensure Requirement :

RN with active license in the state of TN.

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