The Care Coordination Team Lead is responsible for specific functions within the Care Coordination portion of the Care Coordination department. This position oversees the care for high risk populations and oversees a team of care coordinators to ensure assessment of members clinical and psychosocial status, interdisciplinary team approach, education of members in the area of self- management is achieved. This position also provides first line clinical direction to the care coordination staff and refers to Manager of Care Coordination - Medical when necessary.
Current license (without restriction) to practice as a Licensed Practical Nurse or Registered Nurse in the designated State is required. A minimum of 1 year case management/disease management experience. Knowledge of managed care. Knowledge of case management processes including tools and techniques for identification, stratification and management of high-risk members. Must possess working knowledge of MDCH regulations. Knowledge of 5 Star ratings.
- Review predictive model report of each member assigned to their team. Review with care coordinator all cases assigned to team for management.
- Ensures that HRA’s are performed within 90 days of enrollment or identification.
- Along with Manager, reviews HRA to validate initial strat level assigned to member.
- Assists team member in preparing for IDCT and team meetings.
- Participates in IDCT meetings.
- Assists with problem and goal identification
- Reviews each members plan of care
- Direct member contact of members referred by care coordinator for clinical issues and or medication reconciliation.
- Performs discharge planning on select members assigned to team
- Ensure HEDIS is addressed with all members and providers for members assigned to team
- Perform post inpatient calls on select members assigned to team
- Discuss challenging cases with Medical Director assigned to team. Provides recommendations to care coordinators regarding consultation to behavioral health, nutrition, compliance, behavioral health. Oversee workloads by monitoring each care coordinators work list queue to ensure there is a balance of cases by acuity level and referral type of case. Discuss variances that may be identified in team member case load/performance with manager; such as: overdue tasks/cases.
- Provide front line direction to care coordination staff and consult with manager as appropriate for input.
- Identify cases that require team case conferences with the nurse reviewer, behavioral health, nutrition, pharmacy appropriate managers, and plan physician to develop a care plan that will be entered into MCS.
- Provide for ongoing clinical training and education of all staff based on needs assessments done with each staff member to determine areas where more training is required. Coordinate such training with the Care Coordination Clinical Trainer and Manager.
- Assists in oversight of Model of Care goals to ensure goals are achieved
- Work in collaboration with Manager and Trainer to develop job aides for the care coordination staff.
- Acts as a liaison with other MHP departments in relation to care coordination issues.
- Assists Manager in the creation of the agenda for the monthly care coordination team meetings.
- Facilitates weekly team meetings with team members to perform case reviews together.
- Participates in QIA activities and adheres to all regulatory guidelines and standards.
- Consistently demonstrates compliance with HIPPA regulations, professional conduct, and ethical practice.
- Assists with special projects or departmental process improvement efforts, as needed.
- Perform other duties as assigned.
OmniCare Health Plan strives to care for everyone, or at least everyone in the southeast Michigan area. The company provides health...