COMMUNITY BASED NURSE CARE COORDINATOR - MANAGED CARE - CountyCare Health Plan

Cook County•Chicago, IL

1d•$48 - $65

About The Position

The Community Based Nurse Care Coordinator (CBNCC) supports the provision of care coordination in a manner that recognizes the Enrollee and the medical home care teams as essential partners in the Enrollee’s care. These services are offered at the Enrollee’s home, physician appointments, and/or other health care facilities. The CBNCC may work independently or in collaboration with a Community Based Social Worker Care Coordinator if the Enrollee is determined to be socially complex. Makes assessment of potential barriers that impede care or unaddressed complex health needs. Collaborates with Enrollee and medical home care team to develop and implement a plan that mitigates barriers and links Enrollees of any risk level to appropriate resources. The CBNCC works across sites of care and with multiple disciplines to achieve the desired outcomes for the Enrollee.

Requirements

A Bachelor’s degree from an accredited college or university is required. (Must provide original transcripts at time of interview)
Licensed as a Registered Professional Nurse in the State of Illinois, required.
A minimum of one (1) year of work experience with responsibilities for care coordination across multiple healthcare settings and providers is required.
A minimum of one (1) year of experience in utilization management or case management is required.
A minimum of one (1) year of experience in ambulatory nursing, home health or public/community health is required.
Must have access to an insured vehicle and possess a valid Illinois driver’s license for field duties. (Must provide driver’s license and proof of automobile insurance at time of interview).

Nice To Haves

Master’s degree in Nursing, Public Health, or Business from an accredited college or university is preferred.
Prior experience using Milliman or InterQual criteria sets and an understanding of clinical algorithms is preferred.
Experience working with the patient centered medical home model of care delivery is preferred.
Two (2) years of work experience in acute care setting is preferred

Responsibilities

Manages care according to care coordination protocols, policies, procedures, and Enrollee condition.
Assists patients/Enrollees, their support persons, providers and vendors in facilitating optimum covered health care and services.
Interfaces with care teams to ensure the application of care coordination protocols for screening assessment and care planning.
Identifies patient care issues, develops an approach to resolve issues appropriately or escalates to the Manager of Complex Care Coordination.
Provides clinical expertise to care teams when necessary to support coordination of care.
In cooperation with appropriate quality personnel, participates in the development of quality metrics and means of data collection.
Convenes in interdisciplinary care teams.
Performs medication reconciliation.
Prepares reports as requested.
Supports implementation of new workflows to bring health care utilization and cost in alignment with departmental policies and procedures.
Represents department in committees, workgroups as requested.
Travels to Enrollees home or sites of care.
Performs other duties as assigned.