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Job Description Type of Opportunity: Full Time FTE: 1.000000 Exempt: Yes Work Schedule: DaysSummary: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, members 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. Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomesFacilitates 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, members 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.Conducts in depth health risk assessment and/or comprehensive needs assessment which include, but not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. Provides care coordination to members with chronic or complex conditions which require intensive interventions and oversight include multiple, clinical, social and community resources. 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 members 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. Develops and communicates 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 up plans, community based services). Conducts face to face home visits, as required,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. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Generates reports in accordance with care coordination goals.Educates providers, support 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. 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. Complies with Case Management Society of America Standards for Case Management Practice and with CCMC code of Professional Conduct for Case Managers.Participates in Interdisciplinary Care Team (ICPT) meetings.May assist with orientation and continued mentoring of team members as appropriate.Performs other functions as required.REQUIREMENTS:Care Coordinator IHigh School diploma or equivalent and 2+ years relevant work experience in the healthcare field required; managed care experience preferred. Must have a valid driver license, clean driving record, and able to travel locally. Care Coordinator IIAssociate's Degree plus and 2 years of related experience. 3 years of additional experience can be substituted in lieu of an Associate's Degree. Bachelor's degree preferred.Care Coordinator IIIAssociate's Degree in Nursing with active RN license plus 3 years of related experience. 3 years of additional experience can be substituted in lieu of an Associate's Degree. Bachelor's Degree and 3 years of experience preferred. Care Coordinator IVBachelor's Degree and 6 years of related experience. 6 years of additional experience can be substituted in lieu of a Bachelor's degree. Master's degree and 4 years’ experience preferred. Experience in utilization management, quality assurance, home care, community health, long term care or occupational health required. Proficiency in Microsoft Word, Excel and Outlook 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 & private/public resources.Competencies and skills:Nonessential:
SKILL-Critical thinking and attention to detail.
ICD 9 OR 10
SKILL-Microsoft Office
Demonstration of high degree of independent problem solving and critical thinking skills.
SKILL-Ability to deal with all levels of staff and management within the organization, board members, as well as the public, under highly stressful conditions.
SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.
SKILL-Written communication
Benefits are effective day-one (for .45 FTE and above) and include:
Competitive salaries
Full medical, dental and vision insurance
Flexible spending accounts (FSAs)
Free wellness programs
Paid time off (PTO)
Retirement plans, including matching employer contributions
Continuing education and career development opportunities
Life insurance and short/long term disability programs
About Us Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Requisition ID: 2019-11275
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