443449-Complex Care Clinican

443449 Complex Care Clinican
Qualifications: Education: o Bachelor's degree in nursing OR o Nursing School Degree and equivalent relevant work experience
Preferred/Desirable: o 3 years related experience in home health care or health insurance environment o 3 years clinical experience with members who have multiple, chronic or complex health conditions o 2 years experience in care management, care coordination and/or discharge planning o Experience working with Medicaid recipients and community services o Experience with FACETS, CCMS, Interqual or other healthcare database
Certification or Conditions of Employment: o Pre-employment background check o Current unrestricted, applicable, state license to practice as a registered nurse o CCM certification o Valid drivers license
Competencies, Skills, and Attributes: o Strong Motivational Interviewing skills o Strong oral and written communication skills o Ability to effectively collaborate with health care providers and all members of the interdisciplinary team o Demonstrated strong organizational and time management skills o Able to work in a fast paced environment and multi task o Experience with Microsoft Office application, particularly MS Outlook and MS Word and other data entry processing applications o Strong analytical and clinical problem solving skills Working Conditions and Physical Effort: o Regular and reliable attendance is an essential function of the position. o Work is normally performed in a typical interior/office work environment. o No or very limited physical effort required. No or very limited exposure to physical risk.
Responsibilities: Job
The complex care clinician provides care management for the most complex, highest risk members, including those who are homeless, undergoing organ transplantation and with special health care needs. Through the use of assessments, motivational interviewing techniques and evidence based practices the complex care clinician engages with the member and the multidisciplinary team to develop an Individual Care Plan (ICP) that emphasizes self management goals, care coordination, psychosocial supports and on-going monitoring and appropriate follow up. The complex care clinician identifies and addresses barriers to optimal self management and works with the member and team to coordinate care throughout the health care continuum, assisting the member to access all available benefits and resources including family support and community resources. The complex care clinician collaborates with the primary care provider and other members of the interdisciplinary team both internal and external to the plan and works closely with Health Strategies to support and/or co-manage members with behavioral health challenges.
Key Functions/Responsibilities: o Completes a targeted general assessment and applicable condition specific assessments. o Evaluates members' need for complex care management. o Collaboratively develops an individual care plan with the member focusing on the member's goals and objectives, identifying strategies, supports and/or services needed to achieve short and long term goals. o Identifies and addresses barriers to optimal self management and works with the member and team to coordinate care throughout the health care continuum. o Assists the member to access all available benefits and resources including family support and community resources. o Utilizes motivational interviewing techniques to engage members in care management and to coach members regarding health promotion, disease management and preventive health strategies. o Supports and enhances the member's capacity to self-manage. o Evaluates the effectiveness of the care management provided to the member on an on-going basis and updates the ICP accordingly. o Utilizes evidence based practices and guidelines to educate members on specific disease process(es). o Provides or arranges for resources necessary to meet members' psychosocial needs. o Promotes and encourages member collaboration with the primary care provider and other health care providers. o Completes documentation in the medical management information system CCMS in a timely manner and in keeping with contractual requirements, internal policy and NCQA accreditation standards. o Facilitates interdisciplinary consultation on members' behalf through participation in rounds, team meetings and clinical reviews. o Conducts face-to-face visits with selected members as appropriate. o Assists with staff training and mentoring. o Triages cases to nurse care clinician as clinically indicated. o Appropriately utilizes Auxiliary codes per department guidelines. o Maintains HIPPA standards and confidentiality of protected health information. o Adheres to departmental/organizational policies and procedures.
Qualified Candidates ONLY: Send resume to email removed or call 484-434-2972

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