RN LTSS Care Coordinator - Rutherford County
Job ID 2013-25286 # Positions 1
Location US-TN-Nashville
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 12/18/2013
Additional Locations ..
More information about this job:
Summary:
Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.
Responsibilities:
1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team
2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.
3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.
4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.
5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.
6. Reviews benefit options, acquire data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.
7. Other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required: (as appropriate, based upon state contract licensure requirements).
- Nursing Diploma or Associate’s Degree in related Health/Nursing field.
Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing field.
Years and Type of Experience Required:
Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.
Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.
Certifications or Licensures
Required:
- Active licensed RN
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
Language Skills
Required:
- English
Preferred:
- Bilingual (ability to read, write, and speak)
Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.
- Seeks opportunities to acquire new knowledge and skills.
- Accepts feedback openly, without becoming defensive.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Follows up with customers to ensure problems are solved.
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
CB1
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Job ID 2013-25286 # Positions 1
Location US-TN-Nashville
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 12/18/2013
Additional Locations ..
More information about this job:
Summary:
Responsible for conducting telephonic or face-to-face assessments for the identification, evaluation, coordination and management of Members’ needs, including physical health, behavioral health, social services and long term services and supports; develops the Member’s Individualized Service Plan to address those needs. Establishes relationships with referral sources and community resources, while maintaining strict member confidentiality and complying with all HIPAA requirements.
Responsibilities:
1. Responsible for identifying members with potential for high risk complications (such as nursing home admissions) and using knowledge in coordinating appropriate treatment in conjunction with the member and the health care team
2. Responsible for managing members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health services. Seeks to coordinate creative solutions to members’ health care needs while optimizing efficiency and quality outcomes.
3. Obtains a thorough and accurate member history including physical, behavioral, social, biopsychosocial, and environmental factors, and collaborates with the member’s PCP or treating physician and specialists in the development of an Individual Service Plan.
4. Conducts ongoing member assessments to include implementation, coordination, monitoring and evaluation. Utilizes critical thinking skills and applicable managed care criteria to evaluate and identify needs for home and community-based services and/or skilled needs.
5. Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians, etc. that meet the member’s needs; identifies members that would benefit from alternative level of care or other waiver programs and develops an Individual Service Plan based on member needs.
6. Reviews benefit options, acquire data and evaluates necessary services for appropriateness; documents effectiveness of service coordination activities.
7. Other duties as requested or assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required: (as appropriate, based upon state contract licensure requirements).
- Nursing Diploma or Associate’s Degree in related Health/Nursing field.
Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing field.
Years and Type of Experience Required:
Required:
- Minimum of two years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role.
Preferred:
- Experience in home health, health care, discharge planning, behavioral health, collaborating with nursing facilities, community resources, and/or other home and community-based agencies.
- Experience working with Medicare, Medicaid, and managed care programs.
Certifications or Licensures
Required:
- Active licensed RN
- Must possess a valid driver’s license, motor vehicle insurance and access to a motor vehicle, or access to reliable public transportation within the service area.
Language Skills
Required:
- English
Preferred:
- Bilingual (ability to read, write, and speak)
Functional Competencies
- Proficient in the use of Microsoft Office tools. Able to use basic office equipment such as telephone, fax machine and copy machine. Use of Internet and working knowledge in a windows environment to include navigation skills using a mouse, keyboard and number pad Ability to review and draft correspondence in email system and word processing systems.
- Experience working with case or utilization management data systems.
- Solid understanding of the healthcare industry and government insurance programs.
- Seeks opportunities to acquire new knowledge and skills.
- Accepts feedback openly, without becoming defensive.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Follows up with customers to ensure problems are solved.
PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
CB1
Options:
- Apply for this job online
- Email this job to a friend
Go back to the welcome page
Need further assistance·
Powered by the iCIMS Talent Platform (Opens new window)
Applicant Tracking Software
ermHO
