Clinical Claims Care Coordinator RN

About the Company

illumifin is a leading provider of business process outsourcing for the insurance industry, managing over 1.3 million long-term care policies for the nation's largest insurers. We offer unique risk management insight built upon proprietary long-term care databases and foster a culture that promotes respect for people, integrity, learning, and initiative.

Responsibilities

• Reviews onsite assessments for consistency and quality and develops a plan of care in collaboration with the field nurse.
• Identifies and assesses clients' health care needs across a continuum of care.
• Prepares a professional, objective report for the insurance customer summarizing information from the assessment using company formats, based on the basic principles of case management and the Five Steps of the nursing process: assessment, diagnosis, planning, implementation, and evaluation.
• Understands how medical conditions, functional and cognitive deficits affect an individual's safety and incorporates this information into an individualized, comprehensive plan of care.
• Makes the initial contact with the client/family/contact to set expectations for the assessment process and evaluate the need for immediate provider services.
• Coordinates and implements home care services and community resources for clients across a continuum of care.
• Provides ongoing regular evaluation of the appropriateness of services as they relate to changing health conditions of clients.
• Updates the individualized plan of care on an ongoing basis to reflect changing client care needs.
• Obtains information from physicians, family members, third-party payers, caregivers, or other health care providers (such as social workers, adult daycare workers, Medicare nurses) as needed to prepare a comprehensive plan of care and ongoing updates related to care coordination.
• Other duties as assigned.

Requirements

• This position is work from home but requires 2 weeks of training in our Waltham, MA office.