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Care Coordinator II Registered Nurse (RN)- Health Alliance Plan (full-time)

Company: Henry Ford Health System
Location: Southfield
Posted on: October 5, 2018

Job Description:

GENERAL SUMMARY: This position is responsible for case management services provided to the membership of HAP Midwest Heath Plan MI Health Link within the framework of the Annual Case Management Plan. PRINCIPAL DUTIES AND RESPONSIBILITIES: Perform comprehensive clinical and diagnostic assessments for members meeting institutional level of care Clinical and diagnostic evaluation and review of chronic condition information related to complex medical needs, behavioral health needs, activities of daily living (ADL-'s) and instrumental activities of daily living (IADL-'s) for long term supports and waivers Completes medication reconciliation and review Completes Nursing diagnosis of medical conditions Develops Medical health care plans with established goals based on nursing diagnosis, incorporating therapeutic, preventative and rehabilitative nursing actions , including the member, family and caregivers in the planning process Coordinates safe and appropriate discharge planning, transitions of care and follow up care Provides health care instructions to the member as appropriate per assessment and care plan Educates member, family, caregivers and providers on health care plan, assuring competency of personal care staff who service members with complex medical needs. Long term services and supports clinical and diagnostic assessments and care planning for members with complex and chronic conditions including performing and arranging for waiver services and personal care assistance Refer members to community resources for the appropriate agencies and organizations to enhance and supplement services for the member. Examples: Community Mental Health, Area Agency on Aging, Local Health Departments, Meals on Wheels and Transportation Initiates and implements an individual plan of care with attainable goals in conjunction with the member, health care providers, and community agencies. Modifies the plan of care through monitoring and re-evaluation to accommodate changes in treatment or progress for all assigned members in Care coordination contacts include telephonic and face-to-face interaction with members in their homes, inpatient and outpatient settings, and institutional settings Documents the plan of care in accordance with HAP Midwest Health Plan Policies, NCQA guidelines and Medicare/Medicaid requirements within the Case Management Program Performs on-going evaluation of quality and cost effectiveness of Case Management Services Documents care in accordance with Midwest Health Plan Policies Maintains statistical data, reports and logs as required Works with the Concurrent Review Nurse on evaluations of hospitalized members in need of discharge planning, transitions of care, medication reconciliation, and case management. Works with the Referral Coordinator to ensure the member receives the correct and cost effective DME. Interacts with Vendors, Specialists and Primary Care Physicians to authorize and coordinate services for members Presents medically complex cases to the Medical Director for review Presents psychosocial complex cases to Care Coordinator Social Worker Assures maintenance and sharing of records, reports and assures HIPPA compliance. Assists the Director of Health Services with Case Management Program planning, development, implementation and evaluation. Attends identified Plan Committee and Staff Meetings. Other duties as assigned. EDUCATION/EXPERIENCE REQUIRED: Associate-'s degree in Nursing required. Bachelor-'s degree preferred. Minimum of two (2) years of acute hospital experience, e.g., medical/surgical nursing, long-term care, managed care, home health care, behavioral health, waiver or long term support services agencies. Knowledge and understanding of data and managing to clinical, financial and patient satisfaction outcomes. Medicaid/Medicare and /or HMO experience (Managed Care experience), preferred. Minimum of 5 years of experience in acute care, long term care or home health care, behavioral health, waiver or long term support services agencies, preferred. Experience with electronic health and case management systems, preferred. Knowledge and understanding of data and managing to clinical, financial and patient satisfaction outcomes, preferred. Participate in Performance Measurement Criteria by: cost reductions, admission statistics, accuracy of data, and accuracy of interpretation of case management and concurrent reviews. Self-starter who is analytical, organized, intuitive, and investigative. Good written and interpersonal communication skills. Strong problem-solving skills, extensive telephone involvement and Care Management coordination. Manual dexterity to operate PC (MS Word, Excel). Excellent customer service. Knowledge of medical terminology and ICD-9 and CPT coding. Follows State and Federal HMO regulations as related to Utilization Management. CERTIFICATIONS/LICENSURES REQUIRED: Registered Nurse: Licensed Registered Nurse (RN) with the state of Michigan with license in good standing and without prior or current restrictions. Valid Michigan Driver-'s License without restrictions. Registered vehicle with no fault insurance coverage. Certification in Case Management, preferred. $60,278 is the minimum annual salary amount. This rate is the minimum pay for the position. Actual compensation will be based on education, years of experience, and other factors at the time of offer.

Keywords: Henry Ford Health System, Southfield , Care Coordinator II Registered Nurse (RN)- Health Alliance Plan (full-time), Healthcare , Southfield, Michigan

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