This is a work from home position with extensive travel in the community, candidates must reside in the Las Cruces, NM or surrounding area.
Position
CISC Care Coordinator - Las Cruces
Work Location
Las Cruces, NM or surrounding area; work from home with extensive travel in the community.
Responsibilities
- Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes.
- Duties are performed virtually or face-to-face based on contractual requirements.
- Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction.
- Assists with orientation and mentoring of new team members as appropriate.
- Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.
- Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
- Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (e.g., during transition to home care, backup plans, community-based services).
- Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.
- Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
- Acts as an advocate for member`s care needs by identifying and addressing gaps in care.
- Performs ongoing monitoring of the plan of care to evaluate effectiveness.
- Measures the effectiveness of interventions as identified in the members care plan.
- Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes.
- Collects clinical path variance data that indicates potential areas for improvement of case and services provided.
- Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
- Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.
- Facilitates a team approach to the coordination and cost-effective delivery to quality care and services.
- Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.
- Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long-term care services.
- Utilizes licensed care coordination staff as appropriate for complex cases.
- Provides assistance to members with questions and concerns regarding care, providers or delivery system.
- Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
- Generates reports in accordance with care coordination goal.
- The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job.
- A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.
Requirements
- 3-5 years' experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree.
- Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.
- Experience in analyzing trends based on decision support systems.
- Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.
- Knowledge of referral coordination to community and private/public resources.
- Requires detailed knowledge of cost-effective coordination of care in terms of what and how