*** Candidates from MN ONLY***
Care Coordinator - Unable to Reach/Refusal (UTRR)
Work Location: Work from Home with Patient Site visits
As a Care Coordinator – Unable to Reach/Refusal (UTRR), you will be responsible to engage members in care coordination who have previously been unable to reach or refused an assessment, and coordinate services across the continuum of health care to meet the health and/or social service needs of members in Government plan products as assigned. Additionally, you will coordinate member services with appropriate primary care clinics/providers, care systems, specialists, clinic, county, and personnel to achieve the most appropriate and cost-effective member care to optimize the long-term health of the member.
· Collaborate with treatment providers, county and community agencies, and contracted and non-contracted providers to identify and coordinate provision of health care services for Government plan product members.
· Appropriately apply care coordination criteria, protocols and procedures.
· Understand and accurately interpret and apply relevant contractual requirements, policies, procedures and regulations for members which care coordination is a provided service.
· Collaborate with members and/or family members, primary care physicians, clinic staff, providers, and other relevant agencies to assure appropriateness of service that meets member needs and ensures desired outcomes.
· Work closely with engagement specialists, customer service specialists, provider groups and other key stakeholders to investigate member contact information.
· Utilize motivational interviewing skills to engage members in care coordination conversations. Increase follow up of members that are on assigned caseloads to pursue active engagement for all members.
· Responsible for increasing engagement with members, improving response time to email and phone calls as well as tracking performance metrics for members that were moved to active engagement in care coordination.
· Complete in-person assessments and support plans of assigned Unable to Reach and Refusal members.
· Appropriately utilize interpreter services as needed.
· Identify and monitor member needs, including needed preventive medical care, and changes in condition which may warrant early intervention for medical problems.
· Develop support plans to meet each member’s individual needs. Incorporate ethnic and culturally appropriate approaches to care planning.
· Enter member information in the clinical documentation system, Guiding Care software as well as the MnChoices platform. Complete accurate, thorough, and timely required documentation.
· Meet and maintain all established caseload and performance metrics.
· Use appropriate communication tools per contractual and care model requirements.
· Monitor and report all quality-of-care issues through the appropriate internal or external systems.
· Assist with CMS Star Rating initiatives or HEDIS quality initiatives and project improvement planning as appropriate.
· Attend internal and external meetings, including staff meetings and community meetings as needed.
· Provide back-up coverage for other care coordinators as assigned.
· Must have reliable transportation to travel throughout designated counties in Minnesota.
· Other projects and assigned duties.
Education
· B.S. in nursing or B.A. in social work or related field.
· Registered Nurse with a nursing diploma (3 year program) or associate degree in nursing with five or more years’ experience also considered.
· Current and unrestricted Minnesota license as an RN or social worker is required.
· Licensure requirements may depend on assigned product(s).
Required Experience
· Two years’ experience in care coordination/case management across the continuum of health care (hospital, clinic, nursing home, home care etc.) with primary emphasis in working with complex social and medical problems.
· MnCHOICES certified assessor credential in place or with plan to receive assessor credential within 3 months of hire date.
Preferred Experience
· Managed care experience, experience with government programs, particularly Medicare, Medicaid and other State Public Programs.
· Experience working with multi-cultural populations desired.
Job Type: Contract
Pay: $40.00 - $45.00 per hour
Expected hours: 40 per week
Schedule:
Work setting:
Application Question(s):
- Do you live in Minnesota?
Experience:
- Care Coordination: 2 years (Required)
- Unable to Reach/Refusal: 1 year (Required)
Work Location: In person