MSHO/MSC+ Care Coordinator

About the role

This position exists to provide support to patients, their families, and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.

Responsibilities

• Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs.
• Identifies interventions and resources to assist members reaching personal health related goals.
• Identifies patterns and episodes of care that are predictive of future needs and services.
• Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.
• Facilitates integration of patient care by encouraging effective communications between patients, families, providers, health plan and care system programs, and community-based services.
• Adheres to department policy and procedure in daily activities.
• Collaborates with Supervisor, Case Management, Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations.
• Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system.
• Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.
• Provides educational information and materials to members to support preference sensitive decisions.
• Provides regular reporting of member outcomes to Case Management leadership according to defined process.
• Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure.
• Identifies and promptly reports high cost cases for reinsurance.
• Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure.
• Maintains confidentiality of information in accordance with department and corporate policies.
• Establishes and maintains good working relationships within the Comprehensive Care Advocacy department, with other HealthPartners departments, and with other health team participants.
• Supports other team members in achieving patient centered goals.
• Affords assistance to supervisor in maintaining a cohesive Case Management team by contributing to a collaborative, respectful, and diverse environment.
• Participates in and contributes to appropriate departmental and/or organizational meetings.
• Maintains knowledge of and effectively uses automated applications and systems.
• Maintains maximum individual productivity through proficient use of automated systems.
• Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management, patient care services, and benefit packages for development of effective case management skills.
• Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
• Maintains current, active Minnesota nursing licensure. May maintain current, active nursing or social work licensure in other states as assigned.

Qualifications

• Must have current unrestricted license in the State of Minnesota.
• Minimum of 2 years of home and community based experience; experience with relevant utilization review, discharge planning, or case management experience; and current clinical knowledge.
• Demonstrated effective, independent professional judgment and skills.
• Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication.
• Demonstrated working knowledge of quality improvement, utilization management, MSHO/MSC+ plans, fiscal management. Understanding of healthcare and/or MCO industry.
• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.
• MnCHOICES Assessor Certification in place or within 3 months of hire date.