Position Purpose
For use by Arizona, Superior, and Sunflower only. Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available to receive appropriate high-quality care.
Education/Experience
Requires graduate from an accredited school or nursing or a bachelor’s degree and 4–6 years of related experience
Bachelor’s degree in Nursing preferred
License/Certification
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
NP - Nurse Practitioner - Current State's Nurse Licensure required
For Superior: Resource Utilization Group (RUG) certification required
Responsibilities
Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome
Develops and assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and community resources
Coordinates between the member and/or family/caregivers and the care provider team to ensure person-centered care
Monitors care plans and member status, revising plans as necessary to meet goals/needs
Monitors complications and status changes, including eligibility for higher levels of care or waivers
Reviews member data to identify trends and improve quality of care in accordance with regulations
Reviews referrals and intake assessments to develop appropriate care plans
Collaborates with healthcare providers to facilitate services and revise plans as needed
Collects, documents, and maintains all member information to ensure compliance with guidelines
Provides and/or facilitates education to members and families on disease processes, care options, referrals, and benefits
Acts as liaison and member advocate between member/family, physician, and facilities/agencies
Educates on and coordinates community resources; coordinates service authorization for services based on plans
May perform home and/or site visits to assess needs and collaborate with resources
Partners with leadership to improve quality of care and service delivery in a cost-effective manner
May precept clinical new hires and support onboarding to upskill readiness
May provide guidance and coaching to new hires/preceptees within an MCO
May engage during onboarding to complete competency checkpoints for readiness
Collaborates with People Leaders and cross-functional teams to measure readiness
Performs other duties as assigned
Complies with all policies and standards
EEO
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”