Care Coordinator - JHP
Job DetailsWorks with minimal supervision to ensure that comprehensive, patient-centered quality of care, cost effective patient care is offered for members in need of care coordination. All care coordination follows NCQA standards for Complex Case Management and is based on evidence-based guidelines. Review medication profiles member history verify appropriate testing and facilitate office visits with primary care and specialist physicians for members targeted for care coordination services. Coordinate with hospital and provider office case managers, as applicable, to ensure continuity of care and outpatient services when medically appropriate. Coordinate with behavioral health to ensure continuity of care and develop care plans. Perform outreach, education, and follow-up to members based on criteria determined by Operational Guidelines. Utilize community resources to assist in coordinating care to maximize positive health outcomes. Collaborate with other members of Health Partner Plans to perform targeted outreach directed at improving outcomes through screenings and preventive health. Work with practice sites to remove barriers to care, improve member self-management and improve member outcomes.Job Description• Able to work in a constant state of alertness and safe manner.• Conduct timely telephonic outreach to members who have chronic conditions to improve health outcomes to include but not limited to assisting primary care provider offices in coordinating care of members with complex medical needs, utilizing appropriate assessments in software.• Coordinating care for members that is member focused, taking into account the members barriers to care and their personal goals, and documentation within the software that captures the members barriers to care, priority goals, plans of care and schedule for follow up.• Assumes primary responsibility for providing case management for identified members, including home, hospital and provider/ community site visits as appropriate.• Assist primary care provider offices and specialist offices in coordinating care of members. Facilitates accommodations for members with language, communication, visual, or mobility limitations.• Applies knowledge of pathophysiology, psychosocial issues, confidentiality, ethical/legal issues, and therapeutic interventions and sources to assist the membership with problem-solving/decision-making that promotes health, improves level of functioning, and decreases inappropriate use of services.• Educating members concerning their specific health care needs and care options, including palliative care as appropriate, and researching and coordinating care with available community resources.• Researching and coordinating care with member’s behavioral health provider and MCO. Collaborate with Behavioral Health MCO and the members to develop, assist with implementation of, and follow up on interdisciplinary care plans for members with serious persistant mental illness (SPMI).• Infor...