The National Care Coordinator, with the support and guidance of the CareFirst Regional Care Coordinator, supports the development and implementation of the Patient-Centered Medical Home program by telephonically working with patients who are qualified for chronic care coordination and their primary care physicians (PCPs), specialists and other health care providers. The National Care Coordinator will advocate, guide and intervene on behalf of their patients to ensure successful care coordination. This role acts as the primary interface between the Healthways/CareFirst program and individual primary care physicians and their patients. All work is conducted telephonically.
- Identify members who would be candidates for care coordination. Call the PCPs of these members to introduce the PCMH program and gain their participation and cooperation, and subsequently, call the members to introduce the program and gain agreement to participate.
- Assist primary care physicians providing care to the identified members in the development, documentation and implementation of care plans and delivery of care coordination services for patients identified through the CareFirst Patient-Centered Medical Home program. Principle maintainer of the electronic care plan. Utilizes established documentation standards to maintain quality of care plan documentation to include patient progress and barriers to achievement of care plan objectives/outcomes.
- Develop communication and referral mechanisms to assure that there is seamless communication between the CareFirst program, patients, the primary care physician and other health care providers involved with the patients’ care. Utilize established CareFirst unified communication technology as appropriate.
- In conjunction with CareFirst, develop clinical reports for use in primary care office records, facilitating physician engagement with and support of patients in behavior change.
- Assist the patient in coordination of any additional tests, images and consults with specialists, as deemed appropriate by the PCP, in developing the care plan. For assigned patients with multiple prescriptions, assess for efficacy and drug interaction/side effects.
- Assist the patient in mitigating issues and removing barriers to care.
- Conduct patient education in support of Standards of Care guidelines and related health issues using the most appropriate modality for the patient.
- Healthcare background and current licensure as an RN is required. BSN preferred.
Skills and Experience
- The successful candidate will be enthusiastic, a strong communicator, one willing to take initiatives and be confident in talking to Primary Care Physicians regarding CareFirst’s Patient Centered Medical Home.
- Minimum of four years of nursing experience. Experience in the home health, hospital or community-based setting is preferred. Strong consideration is given to an RN who has experience with a PCMH program or similar program, such as hospital transition of care, home health or case management.
- Sales and marketing experience preferred.
- Physician office experience preferred especially working with physicians to make referrals, and providing education to patients telephonically
- Ability to be self-directed, highly organized, and proficient in problem solving skills.
- Strong time management skills and a comfort level with structuring one’s own workflows and prioritization of deliverables and work tasks.
- Exceptional oral, written, and presentation skills.
- Success in influencing patients and providers. Outstanding customer service skills and ability to adapt approach to various personalities.
- Ability to work effectively with all levels of administrative and professional personnel.
- Ability to organize data in support of reporting needs.
- Computer competencies to include word processing, spreadsheet, and presentation preparation. Demonstrated ability to learn customized computer applications. Experience utilizing internet search engines.
- Ability to proactively identify and assimilate QI/QA processes into practice.
- Technical writing skills, including the ability to extrapolate information from a variety of sources including medical records and create concise records that accurately depict the medical “story” of the member.
- Technology expertise with electronic medical record systems, comfort with emails, attachments, utilizing Blackberry and laptop computers.
- Experience with care plan documentation
- Comfort with managing multiple tasks and continually re-prioritizing
- Experience working effectively within a matrix organizational design.
Travel Requirements: None.
This position will be based in the CareFirst Canton office.
For more information and to apply, please click on apply below.
Healthways, Inc. is an equal employment opportunity employer and is committed to a proactive program of affirmative action and diversity development. Healthways, Inc. will continue to recruit, hire, train, and promote into all job levels without regard to race, religion, gender, marital status, familial status, national origin, age, mental or physical disability, sexual orientation, gender identity, source of income, or veteran status.
For three decades, Healthways has been dedicated to improving the human condition. Each year, we learn more and do more for the millions of individuals who count on us to make a difference in their health and well-being. Healthways is a global provider of solutions that help employers, health plans and government agencies enhance business performance and reduce healthcare costs. Our mission is to create a healthier world, one person at a time.
Here at Healthways as we continue to make the world a healthier place, we have also created an environment where people choose to do their best work. Our unique culture thrives on mission-driven individuals who exude a high sense of energy and passion in everything that they do. Collaboration and teamwork are an essential part of everyday life for Colleagues who trust and depend on one another to achieve the highest degree of collective success. We are an organization that strives to recruit the best and the brightest individuals who take pride in the statement "I work for Healthways."