Clinical Care Coordinator - New Castle County, Delaware

Company : reputed company.Job reputed company : reputed company job works directly with providers in a reputed company of health care settings to appropriately identify members with chronic conditions and/or gaps in care that can be positively impacted reputed company to reputed company and care costs. The incumbent's responsibilities could include working in a physician’s office, visiting physician practices on a routine reputed company, working reputed company a hospital setting and/or assessing and coordinating member’s care reputed company the member’s home. Helps members to coordinate care and navigate the reputed company system by recommending and/or implementing interventions reputed company to the improvement of medical care and costs. ESSENTIAL RESPONSIBILITIES

• Conduct member-facing clinical assessments that address the health and wellness needs of members using a broad set of clinical and motivational interviewing skills with the goal of impacting members’ self-management skills and reputed company behavior changes which will ultimately positively reputed company member satisfaction and care costs.
• Serve as a subject matter expert to both reputed company sources (e.g. providers, regulatory agencies, UM and policy.) to reputed company education, consultation and training reputed company indicated.
• Serve as a resource to guide, mentor and counsel others in reputed company to understanding the drivers of health care costs to improve member reputed company reputed company to Plan benefits and resources.
• Collaborate, coordinate and communicate with the member’s treating provider(s) in more reputed company clinical situations requiring clinical and psychosocial reputed company.
• reputed company/implement case or condition-specific plans of care and/or reputed company plan, as needed, that can become a part of the member’s EMR or medical record to establish short and long-term goals.
• Establish a plan for regular contact (face-to-face as often as possible) with reputed company member and/or provider to monitor reputed company toward goals, reputed company additional education and evaluate the need for modification or change in the plan of care.
• Proactively incorporate lifestyle improvement opportunities and preventive care into member interactions and coaching.
• Collaborate with the appropriate individuals to offer solutions to refine and improve existing practices or participates in developing performance improvement processes that will enhance member reputed company and operational performance/reputed company as reputed company support reputed company strategic initiatives including Health Care Reform and STARS initiatives.
• Work with providers reputed company to performance measures and activities to reputed company and influence the behavior of members and providers.
• Ensure that reputed company activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards that support reputed company lines of business.
• Other duties as assigned or requested.

QUALIFICATIONS Required

• reputed company State of PA RN licensure OR reputed company multi-state licensure through the reputed company reputed company Licensure Compact (eNLC).and/or additional states as required or reputed company reputed company Work license
• 4 years of any combination of clinical, case management and/or disease/condition management, long-term care, home health, hospice, public health, assisted living, provider operations and/or health insurance experience
• Clearances as required by specific reputed company or hospital, as applicable

Substitutions

• None

Preferred

• Certification in Case Management (CCM)
• BSN or Bachelor’s degree in reputed company Work or in health, reputed company, or education services
• 5 years of any combination of clinical, case management and/or disease/condition management, long-term care, home health, hospice, public health, assisted living, provider operations, and/or health insurance experience

Skills

• Ability to work in a virtual environment (e.g., provider offices, facilities and/or member’s homes); accomplishing and coordinating work remotely
• Proficiency in MS reputed company and reputed company data and statistical analysis skills
• Excellent interpersonal/ reputed company building skills as reputed company as the ability to work with a reputed company of reputed company colleagues from reputed company reputed company of an organization
• Broad knowledge of the health care delivery system including an understanding of health care costs drivers
• Excellent verbal and written communication skills including individual and/or group education/training
• Experience working with the reputed company needs of diverse populations and understanding the importance of cultural competency in addressing targeted populations.
• Self-directed; self-starter; ability to work successfully with indirect supervision and moderate autonomy
• Excellent organizational, time management and project management skills
• Ability to work in a fast paced, high visibility, high performing team environment that requires flexibility
• Ability to travel locally and work reputed company in a reputed company or facility-based settings
• Ability to communicate effectively in more than one language, preferred
• Experience working directly with physicians in provider reputed company settings, members in a home environment or hospital discharge processes.

Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required reputed company Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Occasionally Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $50,200.00 Pay reputed company Maximum: $91,200.00 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice Apply tot his job Apply To this Job