Care Coordinator II - LCMC

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are 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, we are the state's largest private employer with nearly 14,000 employees—including more than 1,600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care), and Commercial health plans.

Location

211 Sudderth Dr, Ruidoso, NM 88345-6002

Responsibilities

• 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 the member, caregivers, member’s legal representative, physician, care providers, and ancillary support services—to address care issues, specific member needs, and disease processes (medical, behavioral, social, community-based, or long-term care services).
• Coordinates care of individual clients with application to identified populations using assessment, care planning, implementation, coordination, monitoring, and evaluation for cost-effective and quality outcomes.
• Supports patients in hospital, inpatient, or clinic settings.
• Provides care coordination to members with chronic conditions and less complex needs, including limited community resources.
• Conducts in-depth health risk assessments and/or comprehensive needs assessments covering psycho-social, physical, medical, behavioral, environmental, and financial parameters.
• Develops and communicates plans for authorization of services, serving as the point of contact to ensure services are rendered appropriately (e.g., during transitions to home care, backup plans, community-based services).
• Assesses and reviews the plan of care regularly to identify gaps, trends, and opportunities to improve health and quality of life outcomes; collects clinical path variance data to identify potential areas for improvement of case and services provided.
• Works with members and the interdisciplinary care plan team to adjust the plan of care as necessary.
• Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.
• Develops, documents, and implements plans addressing 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 and measures the success of interventions as identified in the member’s care plan.
• Provides assistance to members with questions and concerns regarding care, providers, or the delivery system.
• Conducts face-to-face home visits as required.
• Educates providers, support staff, members, and families about the care coordination role and health strategies, focusing on a member-centered approach to care.
• Maintains professional relationships with external stakeholders, such as inpatient, outpatient, and community resources.
• Promotes the appropriate use of clinical and financial resources to improve the quality of care and member satisfaction.
• Generates reports in accordance with care coordination goals.
• Participates in Interdisciplinary Care Team (ICPT) meetings.
• Assists with the orientation and mentoring of new team members as appropriate.
• Performs other functions as required.

Requirements

• Associate’s Degree (3 years of additional experience can be substituted in lieu of an Associate’s Degree). Bachelor’s degree preferred.
• 2 years of related experience.
• Must have a valid driver’s license, clean driving record, and ability to travel locally.
• Experience in utilization management, quality assurance, home care, community health, long-term care, or occupational health required.
• CCM certification preferred or must obtain within 3 years of hire.
• Proficiency in Microsoft Word, Excel, and Outlook required.
• Experience analyzing trends based on decision support systems.
• Business management skills, including cost/benefit analysis, negotiation, and cost containment.
• Knowledge of referral coordination to community, private, and public resources.

Benefits

• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities.
• Staff safety: A wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern.
• Differentials for night/weekend shifts, higher education, certifications, and various lead roles (for eligible positions).
• Malpractice liability insurance.
• Loan forgiveness through the New Mexico Higher Education Department.
• EPIC electronic charting system.
• Access to a fun, engaging, and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges, and more.

Pay

Pay Range Minimum Offer: $27.52 per hour
Maximum Offer: $46.86 per hour

Schedule

• Type of Opportunity: Full time
• FTE: 0.90
• Work Shift: 10 Hour Days
• Job Exempt: No