Care Coordinator III

Overview

Now hiring a Care Coordinator III-Raton, NM

Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across thecontinuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member s legal representative, physician, care providers, andancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term careservices. Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring andevaluation for cost effective and quality outcomes

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based Raton, NM
• Work hours: Weekday Schedule Monday-Friday
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:

• Experience in utilization management, quality assurance, home care, community health, long term care or occupational health required. CCM certification preferred or must obtain within 3 years of hire.
• Proficiency in Microsoft Word, Excel and Outlook required. Experience in analyzing trends based on decision support systems.

Qualifications

• Masters Degree & 2 years exp, Bachelors degree & 4 years exp, Associates degree & 5 years exp, 10 years of exp may be utilized in lieu of other education & exp reqs.

Responsibilities

• Supports Health plan members
• Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.
• Collaborates with the interdisciplinary care plan team which may include member, caregivers, member s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term careservices.
• Provides care coordination to members with chronic condition with less complex needs including less community resources. Conducts in depth health risk assessment and/orcomprehensive needs assessment which include but not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. Develops andcommunicates plan for authorization of services, and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back upplans, community based services).
• Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes; collects clinical path variance data that indicatespotential areas for improvement of case and services provided; works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
• Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan whichprovides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for member s care needs by identifying andaddressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the memberscare plan.
• Provides assistance to members with questions and concerns regarding care, providers or delivery system.
• Conducts face to face home visits, as required.
• Educates providers, support staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitatesa team approach to the coordination and cost effective delivery to quality care and services.
• Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
• Promotes the appropriate use of clinical and financial resources in order to improv