Nurse Care Coordinator

Other Atlanta, Georgia Opportunities available throughout U.S.


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.

OPPORTUNITIES AVAILABLE IN ANY STATE WITHIN THE U.S.

Job Summary:

Performs all functions delineated in the CSH 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.
    • NLC license or Licensed in Georgia AND South Carolina
  • 1-3 years Managed Care experience in Care Management.
  • Working knowledge of Medicare Advantage plans.
  • Bilingual strongly preferred.
  • CCM certification strongly preferred.
  • Strong analytical skills.
  • Strong computer skills – Microsoft Office Suite.
  • Strong communication and interpersonal skills.