- Collaborate with treatment providers, county, and community agencies, as well as contracted and non-contracted providers to identify and coordinate provision of health care services for Government plan product members. Appropriately apply case management criteria, protocols, and procedures.
- Understand and accurately interpret and apply relevant contractual requirements, policies, procedures, and regulations for members which care coordination is a provided service.
- Collaborate with members and/or family members, primary care physicians, clinic staff, providers, and other relevant agencies to assure appropriateness of service that meets member needs and ensures desired outcomes.
- Work closely with engagement specialists, customer service specialists, provider groups and other key stakeholders to investigate member contact information.
- Utilize motivational interviewing skills to engage members in care coordination conversations. Increase follow up of members that are on assigned caseloads to pursue active engagement for all members - at least bi-monthly efforts will be required.
- Responsible for increasing engagement with members, improving response time to email and phone calls as well as tracking performance metrics for members that were moved to active engagement in care coordination.
- Complete in-person health risk assessments and care plans of assigned Unable to Reach and Refusal members. Appropriately utilize interpreter services as needed. Identify and monitor member needs, including needed preventive medical care, and changes in condition which may warrant early intervention for medical problems. Develop care plans to meet each member's individual needs. Incorporate ethnic and culturally appropriate approaches to care planning.
- Enter member information in the clinical documentation system, Guiding Care software. Complete accurate, thorough, and timely required documentation.
- Meet and maintain all established caseload and performance metrics.
- Use appropriate communication tools per contractual and care model requirements.
- Monitor and report all quality-of-care issues through the appropriate internal or external systems.
- Assist with CMS Star Rating initiatives or HEDIS quality initiatives and project improvement planning as appropriate.
- Attend internal and external meetings, including staff meetings and community meetings as needed.
- Provide back-up coverage for other care coordinators as assigned.
- Must have reliable transportation to travel throughout designated counties in Minnesota.
- Other projects and duties as assigned.
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RN Care Coordinator
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care coordinator - Minneapolis, MN , USA, United States - UCare Minnesota
Description
ABOUT UCARE
UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission.
A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other.
Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began.
Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
Position Description
As a Care Coordinator - Unable to Reach/Refusal (URR), you will be responsible to engage members in care coordination who have previously been unable to reach or refused a health risk assessment.
Coordinate services across the continuum of health care to meet the health and/or social service needs of members in Government plan products as assigned.
Coordinate member services with appropriate primary care clinics/providers, care systems, specialists, clinic, county, and UCare personnel to achieve the most appropriate and cost-effective member care to optimize the long-term health of the member.
care coordinator professionals in Minneapolis
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Marlene Rodriguez Souvannarath
Skilled and Goal-Oriented Worker
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Kelly Brabec
Clinical Documentation Integrity Advisor, RN