The RN Care Coordinator is responsible for completing comprehensive assessments, individual care plans, discharge planning and actively managing members’ care in coordination with the UM staff, the Primary Care Provider, family members, community resources, and the member. Job functions are performed in accordance with requirements of the QUEST contract, the Medicare contract, AlohaCare’s policies and procedures, and URAC standards.
Primary Duties and Responsibilities:
Required Competencies and Qualifications:
- Complete all referral forms (when applicable) for the initiation of case management services.
- Collect all pertinent documentation to make a determination, based on referral information and COMPASS triggers, for the need of case management services.
- Contact members for completion of the Medical Information Questionnaire/ Assessment (MIQA) form.
- Complete the COMPASS Initial Determination Tool (IDT) in conjunction with clinical staff and the member’s PCP, family, representative payee and others involved in the member’s care.
- Complete an Individualized Care Plan (ICP) for each member admitted to a level of case management care.
- On-going monitoring of the member’s physical, psychological, financial, daily living skills, and other care initiatives, needs and facilitating services as directed by the clinical review team.
- Complete on-going reassessments of the member’s case management needs.
- Coordinate services with other sources of care, PCP, specialists, family members and behavioral health providers.
- Present CC/CM activities (ICP and Assessments) at Case Review Team meetings for review with AC Medical Director.
- Complete member call list on a weekly basis and provide supervisor/manager with productivity tracking reports.
- Generate and monitor utilization reports and member service reports.
- Screen and coordinate services for specialty populations.
- Identify and refer members for disability determination as appropriate.
Education / Licensure Requirements:
- Ability to work without close supervision, to problem solve, to make basic decisions independently, and to pay attention to detail in developing and documenting Individualized Care Plans and case management/care coordination activities.
- Ability to work in high stress environment at times, with pressure of multiple deadlines on multiple cases with varying priorities.
- Ability to deal with volatile providers, members and family members in person or over the phone and to support AlohaCare’s corporate core values in all interactions.
- Strong knowledge of community resources including: specialty care, behavioral health care resources, inpatient and outpatient community resources.
- Knowledge of the managed health care field (both conceptually and operationally).
Preferred Competencies and Qualifications:
- Licensed Registerd Nurse and three (3) years clinical practice experience
- Bachelors Degree or higher in a health related field as a health professional
Additional Job Requirements:
- Certification as a Case Manager through a URAC approved entity
- Managed Care experience
- 2-3 years work experience as a case manager in a community setting.
- Proficiency in Microsoft Word and Outlook with basic understanding of and ability to enter data/run reports from Excel or Access databases.
An Equal Opportunity Employer
- Current valid State of Hawaii Drivers License
- Travel locally on regular basis with occasional inter-island travel
- Provide training internally and externally as necessary with providers, and community based programs.