| Clinical RN - Field-Based
Summary:
In accordance with UAC policies and procedures, provide effective field –based case management and care coordination services to identified high risk patients such that UAC achieves its quality of care, cost and patient satisfaction goals. The primary objective of this position is identify and resolve clinical and social issues to maximize the opportunity that assigned patients can live at home, safely, adhere to appropriate medications, actively connected with his/her primary care physician, and if appropriate, be compliant with a well-developed patient care plan. The Field Based Care Manager is expected to fully utilize their professional training, the tools and support systems available to them, available internal and community clinical and support resources and supportive behavior change strategies to achieve favorable patient health outcomes. Critical measures of success are compliance with CMS and UAC policies, eliminating avoidable admissions, reducing ER visits and readmissions and achieving a high degree of medication adherence.
Responsibilities:
- Coordinate and facilitate member’s hospital stay and discharge needs with facility, health services providers, member, and care giver.
- Face to face close facilitation of transition from a facility to home assuring all medical, functional and basic needs are met to guarantee smooth and sustainable transition.
- Facilitate communication with member’s providers. Serve as member’s advocate to clearly communicate needs and problems.
- Collaborate with member, physician and other health care providers to establish a plan of care to meet the member’s individual needs.
- Ongoing assessment, intervention and resolution of member’s needs. Includes, but not limited to addressing medical, ADL/IADL, DME, rehab services, transportation, environmental needs. High priority to utilizing existing support system, local and community resources.
- Ongoing coaching of member/family/care giver to achieve the highest level of self-management according to each individual member ability.
- Participate in the interdisciplinary case reviews for collaborative assessment and coordination planning to ensure quality of care.
- Instruction on how to access program resources and staff, provider and community resources.
- Complete all appropriate assessments and documentation in the Plan’s system.
- Consult and work closely with the Medical Director regarding complex clinical issues.
- Consult and work closely with program pharmacists to address medication issues, complexity, adherence and reconciliation.
- Prepare pertinent member information for internal case conferences and implement recommendations.
- Take calls from members and providers and give them appropriate information to help expedite services.
- Conduct daily tracking of caseload as assigned.
- Comply with all departmental policies and procedures.
- Participate in departmental and company in-services as appropriate.
- Comply with Customer Service expectations as applicable to the Department and Health Plan.
- Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.
- Must comply with company’s Immunization policy and procedure.
- And all other duties assigned by the manager and/or supervisor.
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Required Skills
- Problem solving skills with the ability to look for root causes and implementable, workable solutions. “Go getter” approach essential
- Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization
- Organizational skills with the ability to handle multiple tasks and/or projects at one time
- Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
- Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements
- Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs
- Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
- Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company
- Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization
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Required Experience
- RN current NYS licensure - required
- Minimum of 3 years utilization management and/or case/disease management experience within a hospital, home health setting or managed care company – required
- Experience working in a field based setting with prioritization of tasks – strongly preferred
- Experience working with Medicare / Medicaid/MLTC preferred
- CCM and/or related certification or eligibility is a plus
- Personal computer experience should include working with Microsoft Word, Excel, PowerPoint
- and Outlook at the intermediate level at a minimum
- Maintains a valid driver’s license for any required facility on-site and home visits
Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce. |
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| Work Environment / Physical Demands: |
Work is performed as a telecommuter. Working extended hours may be required as needed.
The physical demands for this position include exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently to lift, carry, push, pull or otherwise move objects, including the human body. This is considered sedentary work, which involves sitting most of the time; walking and standing are required, as well on occasion. Telephone work and/or computer work are typically required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. |