CARE MANAGEMENT NURSE COORDINATOR - MANAGED CARE Job Number: 00124436 Job Posting : May 21, 2020, 4:23:29 PM Closing Date : Jun 5, 2020, 4:59:00 AM Full-time Collective Bargaining Unit: None Posting Salary: COMPETITIVE Organization: Health and Hospital Systems JOB SUMMARY :
LOCATION: 600 W. Jackson Blvd., Chicago, IL. 60661 SHIFT: DAYS Under the direction of the Manager of Care Management-County Care, the Care Management Nurse Coordinator works closely with network providers, delegated Care Management Entities (CMEs), benefit managers and managed care staff to coordinate services for members. This position contributes toward the development, implementation, evaluation and continuous improvement of the care management services for CountyCare. The incumbent acts as a liaison to care management teams ensuring the staff operates in adherence to CountyCare protocols, policies, and procedures. Typical Duties - Collaborates on the development of care management protocols, policies, and procedures . the development of care management protocols, policies, and procedures .
- Outreaches and responds to CountyCare members, providers or vendors to assess needs, obtain relevant information, develop appropriate plans and clearly communicate expected actions to meet members' needs; escalates unresolved needs appropriately to Manager, Medical Director or other appropriate leader
- Documents all activities in care management system according to established policy and procedure
- Works with providers and vendors to ensure use care management, disease management, utilization management, and pharmacy protocols.
- Provides clinical expertise when necessary to support coordination of care.
- Collaborates on development of quality metrics and data collection.
- Participates in patient care rounds with network providers and vendors.
- Reports incidents of suspected abuse, neglect and exploitation according to established policy and procedure
- Prepares reports and submits for review as requested.
- Represents Clinical Services department in committees, workgroups as requested by the Manager of Care Management-County Care, etc.
- Ranks and manages competing priorities and completes both member care plans and other assignments within appropriate time frames.
- Performs other duties as assigned.
Reporting Relationships
Reports to the Manager of Care Management-County Care Minimum Qualifications - Licensed as a Registered Professional Nurse in the State of Illinois.
- Bachelor's degree from accredited college or university
- Two (2) years' work experience in care coordination or case management as primary responsibility
- Two (2) years of work experience in acute care nursing
- One (1) year of work experience in a managed care organization or health plan
- One (1) year of experience in ambulatory nursing, home health or public/community health
- Prior experience creating and implementing plans of care for complex patients.
- Prior experience working with Medicare, Medicaid, and Third Party Payer review requirements
- Prior experience working with medically underserved population(s)
Preferred Qualifications - Master's degree from an accredited Master's program in Nursing, Public Health, or Business
- Prior experience using Milliman or InterQual criteria sets, and an understanding of clinical algorithms.
- Experience working with the patient centered medical home model of care delivery
- Experience working with mental health care and/or substance use disorder treatment services
Knowledge, Skills, Abilities and Other Characteristics - Knowledge of the social determinants of health and interventions to provide effective health care to persons living in poverty
- Strong interpersonal skills: ability to establish strong working relationships and to communicate, effectively with leadership team, patients/members, primary care site leaders, physicians and clinicians, behavioral health team members and other care providers
- Strong written and verbal communication skills
- Proficiency with Microsoft Office products (Word, Excel, PowerPoint, Outlook)
- Ability to contribute well to team based work
- Ability to communicate in a confidential and HIPAA compliant manner
- Ability to maintain appropriate professional boundaries with all staff, trainees, and patients at all times.
- Ability to demonstrate respect and sensitivity for cultural diversity patients and coworkers
- Ability to work autonomously and consult appropriately
- Ability to develop and execute patient care plans and advocate effectively for member/patient needs to achieve optimal health outcomes
- Ability to appropriately manage and rank competing priorities and complete both patient/member care plans and other assignments within appropriate time frames
VETERAN PREFERENCE PLEASE READ When applying for employment with Cook County Health, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service To take advantage of this preference a Veteran must : -
Meet the minimum qualifications for the position. -
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?" -
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable. OR
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing. If items are not attached, you will not be eligible for Veteran Preference VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
Benefits Package - Medical, Dental, and Vision Coverage
- Basic Term Life Insurance
- Pension Plan
- Deferred Compensation Program
- Paid Holidays, Vacation, and Sick Time
- You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/ MUST MEET REQUIRED QUALIFICATIONS AT TIME OF APPLICATION
*Degrees awarded outside the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
*CCH is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER |
