Nurse Care Coordinator

Managed Care Park Ridge, Illinois


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security.  Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina.  In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.

Job Summary:

Performs all functions delineated in the Clear Spring Health Care Management Program description, including activities and projects in support of Quality Improvement.

Main Accountabilities:

  • Serves as Member advocate, assessing and assuring quality care is given.
  • Identifies high risk factors, barriers to goals, and strengths that will assist the Member in achieving goals.
  • Assists the Member in managing their health conditions, prioritizing their health care needs, and preventing complications.
  • Coordinates care in conjunction with multidisciplinary healthcare team, the Member, and other providers.
  • Provides timely reviews of the care plan with the Member as necessary, re-evaluates and modifies the plan of care based on Member outcomes.
  • Regularly communicates with the Member to maximize care opportunities.
  • Provides self-management support to the Member and refers to other resources as appropriate.
  • Provides necessary and appropriate education materials to the Member.
  • Conducts telephonic and other outreach to the Member before, during, and after specific healthcare interventions, in order to facilitate services and/or follow-up care.
  • Provides and ensures accurate clinical documentation in the care management system.
  • Promotes effective and efficient utilization of clinical resources and services.
  • Establishes and maintains collaborative relationships with internal team members and external providers.
  • Partners with team in the evaluation and support of quality initiatives (HEDIS and STARS).
  • Promotes team environment.
  • Other tasks and duties as assigned.

Qualifications:

  • Licensed Registered Nurse.
  • 1-3 years Managed Care experience in Care Management.
  • Working knowledge of Medicare Advantage plans.
  • Bilingual strongly preferred.
  • CCM (Certified Case Manager) certification strongly preferred.
  • Strong analytical skills.
  • Strong computer skills – Microsoft Office Suite.
  • Strong communication and interpersonal skills.