Care Coordinator - RN (New Orleans Team)
Location: New Orleans Louisiana
Description: Peoples Health, Inc. is presently looking of Care Coordinator - RN (New Orleans Team) right now, this occupation will be placed in Louisiana. For detail informations about this occupation opportunity kindly see the descriptions. As part of the primary care patient centered medical home team, the RN Care Coordinator engages in a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates options and services to meet a member's health needs through communication and available resources to promote quality, cost effective outcomes. This process will be applied in various settings to include acute care, skilled nursing care settings, long term acute care settings, rehab facilities, custodial care, ambulator! y settings and in the member's home. The Care Coordinator RN f! unctions as part of a multidisciplinary team which includes a Navigator, Social Worker, Chronic Care Nurse, Pharmacist and Nurse Practitioner.
Responsible for the management of an assigned population of members as part of the patient centered medical home model.
Responsibilities:
Addresses the total individual, inclusive of medical, psychosocial, behavioral, cultural and spiritual needs
As appropriate, conducts comprehensive assessments of the member's health and psychosocial needs, including health literacy status and deficits
Involves the individual member and care giver, as appropriate, in decision making
Collaborates in efforts that focus upon moving the individual to self care when possible
Applies focus on points of care transitions, which includes a complete transfer to the next care setting provider that is effective, safe, timely and complete
Provides prompt, courteous, excellent service to internal and external cust! omers at all times
Facilitates communication and coordination between all members of the health-care team
Interacts with the member and the multidisciplinary team to establish measurable health care goals and prioritization of the member;s needs. Monitors the member's adherence to the plan of care. Identifies barriers to adherence to the plan of care
Promotes a professional positive image of Peoples Health throughout the community. Identifies and communicates community concerns and problems affecting Peoples health to appropriate departments
Educates the member, the family or caregiver, about disease states and treatments, plan benefits, community resources and resource options. Evaluates the member's readiness and ability to learn
Encourages the appropriate use of health care resources
Collaborates with practice team members and market medical directors to facilitate appropriate treatment of members
Participates in medical home and market team m! eetings to improve member outcomes and Peoples Health processes
Rev! iew daily facility census for assigned population
When indicated by the needs of the patient (high risk, readmission, frequent Emergency Department visits, SNP) coordinates on-site reviews to develop a realistic discharge plan that will facilitate continuation of care at the most appropriate level. Review will include quality of care, utilization pattern, and compliance with policy guidelines, in accordance with InterQual criteria
Coordinate concurrent review of reassigned members in SNF/LTAC/REHAB locations and coordinate with facilities for discharge
Document appropriate in the Peoples Health CCMS System
Identify and plan all follow-up to hospital treatment with the medical home team and primary care physician. Document review updates in CCMS update census, update discussions/events involving individuals responsible for a patient's welfare
Participate in meetings with PCP for review of the census as indicated
Communicate discharge information to th! e Navigator
Coordinate with the Navigator to facilitate the post hospital discharge visit within 7 days
Answer pages and phone calls received from hospital utilization review regarding a patient's condition during business hours
Develop referrals to appropriate resources to assist member and/or caregiver in continuation of care in an outpatient setting
If necessary, coordinate with he patient and/or caregiver to identify potential barriers to discharge to an alternate level of care
Complete Service Forms in accordance with department policy including time-lines and Standards of Documentation
Participate with the medical home team in the monthly review of assigned members including SNP members
Promote quality outcomes and participates in the measurement and understanding of those outcomes
Monitor performance against assigned members gaps in HEDIS and STAR measures through weekly report analysis
Utilizes evidence-based guidelines, as availa! ble, in their daily practice
Pursues professional excellence and ma! intains competence in practice through ongoing learning and education
Qualifications:
Diploma or degree in nursing required; Bachelors in Nursing preferred. Minimum of 3 years health care experience as a RN required. Previous case management experience or previous managed care experience as a RN highly preferred. In-depth knowledge of utilization management, managed care delivery, Medicare and complex case management planning preferred. Excellent verbal and written communication skills are required. Must be able to interface with multi-faceted medical professionals and non-medical staff. Computer skills and knowledge of general office machinery required. Strong leadership and decision making skills are needed. Understanding of HMO and third party administration preferred.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Peoples Health, Inc..
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This occupation starts available on: Wed, 27 Nov 2013 04:25:09 GMT