护理协调员 - CISC
Care Coordinator- CISC
协调特定客户群体的护理工作，通过评估、护理计划、实施、协调、监测和评估，以实现成本效益和高质量的结果。根据合同要求，工作方式可以是虚拟或面对面进行。促进临床和财务资源的合理使用，以提高护理质量和会员满意度。根据需要协助新团队成员的入职培训和指导。
- 为被识别并评估为需要强化干预和监督的有行为健康状况的会员提供护理协调。
- 进行深入的健康风险评估和/或全面的需求评估，包括但不限于心理社会、身体、医疗、行为、环境和财务参数。
- 与相关方沟通并制定护理计划，作为联系点以确保服务按适当方式提供（例如，在过渡到家庭护理期间、备用计划、基于社区的服务）。
- 实施、协调并监控针对会员和家庭的策略，以改善健康和生活质量结果。
- 制定、记录并实施计划，以提供适当的资源来满足社会、身体、心理、情感、精神和支持需求。
- 通过识别和解决护理中的缺口，成为会员护理需求的倡导者。
- 对护理计划进行持续监测，以评估其有效性。
- 根据会员护理计划中确定的干预措施，衡量其有效性。
- 定期评估和审查护理计划，以发现护理中的缺口、改善健康和生活质量的趋势。
- 收集临床路径偏差数据，以表明案例和服务改进的潜在领域。
- 在必要时与会员和跨学科护理计划团队合作调整护理计划。
- 教育提供者、支持人员、会员和家庭有关护理协调的角色和健康策略，重点是以会员为中心的护理方法。
- 推动团队协作，以实现高质量护理和服务的成本效益交付。
- 推动团队协作，包括跨学科护理计划团队，以确保在全过程中采取适当的干预措施，实现高质量护理和服务的成本效益交付。
- 与其他团队合作
查看英文原文
Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties are performed virtually or face-to-face based on contractual requirements. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate.
· Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.
- Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
- Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (e.g., during transition to home care, backup plans, community-based services).
- Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.
- Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
- Acts as an advocate for member`s care needs by identifying and addressing gaps in care.
- Performs ongoing monitoring of the plan of care to evaluate effectiveness.
- Measures the effectiveness of interventions as identified in the members care plan.
- 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 indicates potential areas for improvement of case and services provided.
- Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
- Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.
- Facilitates a team approach to the coordination and cost-effective delivery to quality care and services.
- 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 care services. Utilizes licensed care coordination staff as appropriate for complex cases.
- Provides assistance to members with questions and concerns regarding care, providers or delivery system.
- Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
- Generates reports in accordance with care coordination goal.
The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.
Other Job Requirements
Responsibilities
3-5 years' experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree., Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.
Experience in analyzing trends based on decision support systems.
Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.
Knowledge of referral coordination to community and private/public resources.
Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data.
Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking.
Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols.
Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures.
Ability to maintain complete and accurate enrollee records.
Effective verbal and written communication skills. Ability to work well with clinicians, hospital officials and service agency contacts.General Job Information
Title
Care Coordinator- CISCGrade
22Work Experience - Required
Clinical, QualityWork Experience - Preferred
Education - Required
GED, High SchoolEducation - Preferred
Associate, Bachelor'sLicense and Certifications - Required
DL - Driver License, Valid In State - OtherOtherLicense and Certifications - Preferred
CCM - Certified Case Manager - Care MgmtCare Mgmt, LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare MgmtSalary Range
Salary Minimum:
$50,225Salary Maximum:
$75,335This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Originally posted on Himalayas