Clinical Liaison
Job ID 2013-22533 # Positions 1
Location US-TN-Nashville
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 4/9/2013
Additional Locations ..
More information about this job:
Summary:
Partner with health plan departments and Medical Director(s) as well as the associated health plan and corporate personnel to integrate case management services and population-specific health coaches into the Medical Home. Supports the Medical Home’s capacity to provide individual care coordination and complex case management by the primary care practice.
Responsibilities:
1. Provide guidance in assessing the level and type of clinical care management services required by the Medical Home member.
2. Serve as a subject matter expert on health care projects, providing coaching and support to staff assigned to the project.
3. Recognize and evaluate clinical care gaps of the designated Medical Home members.
4. Collaborate with the Medical Home (MH) staff and Medical Practice Consultant (MPC) to create appropriate clinical intervention programs based upon the clinical complexities of the MH member and provide clinical guidance and direction to the Health Plan Case Management team to execute on identified programs.
5. Establish deliverables and monitor progress for each clinical care management plan that supports the specific identified clinical care gaps.
6. Suggest and encourage the use of appropriate community based member visitations and resources as integral to the care management process.
7. Utilize data sharing and routine reports (i.e. CI3, daily census, HEDIS, ER census, Provider Quality Incentive Program) to support the design and management of member specific care plans, a communication plan for progress updates, and opportunities to integrate a quality outcome strategy.
8. May manage a member caseload and/or travel to project sites as appropriate.
9. Perform other duties as assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Nursing Diploma or Associate’s Degree in related Health/Nursing field.
Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing/Social Work/Psychology
Years and Type of Experience Required:
Required:
- Minimum of five years relevant work experience.
Preferred:
- Experience in health services program development, administration, and evaluation.
- Experience working on the community level and with community agencies.
- Experience in managed care, case management and discharge planning Certifications or Licensures (as defined by specific program needs).
Required:
- Active licensed RN, LPN/LVN, LSW or LCSW, LMSW, NP, LPC, PA, CRNP
Preferred:
- Certified Case Manager
Language Skills
Required:
- English
Preferred:
- Bilingual
Functional Competencies
- Working knowledge in a windows environment (MS Word, Excel, Outlook, PowerPoint) to include navigation skills using a mouse and keyboard including use of internet.
- Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.
- Ability to apply creative/breakthrough methodologies and thinking to the tasks.
- Strong communication skills, written and verbal; articulate, persuasive & influential; systematic and timely.
PHYSICAL RESPONSIBILITIES
The PHYSICAL REQUIREMENTS described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
Job ID 2013-22533 # Positions 1
Location US-TN-Nashville
Search Category Case Management
Type Regular Full-Time (30+ hours) Posted Date 4/9/2013
Additional Locations ..
More information about this job:
Summary:
Partner with health plan departments and Medical Director(s) as well as the associated health plan and corporate personnel to integrate case management services and population-specific health coaches into the Medical Home. Supports the Medical Home’s capacity to provide individual care coordination and complex case management by the primary care practice.
Responsibilities:
1. Provide guidance in assessing the level and type of clinical care management services required by the Medical Home member.
2. Serve as a subject matter expert on health care projects, providing coaching and support to staff assigned to the project.
3. Recognize and evaluate clinical care gaps of the designated Medical Home members.
4. Collaborate with the Medical Home (MH) staff and Medical Practice Consultant (MPC) to create appropriate clinical intervention programs based upon the clinical complexities of the MH member and provide clinical guidance and direction to the Health Plan Case Management team to execute on identified programs.
5. Establish deliverables and monitor progress for each clinical care management plan that supports the specific identified clinical care gaps.
6. Suggest and encourage the use of appropriate community based member visitations and resources as integral to the care management process.
7. Utilize data sharing and routine reports (i.e. CI3, daily census, HEDIS, ER census, Provider Quality Incentive Program) to support the design and management of member specific care plans, a communication plan for progress updates, and opportunities to integrate a quality outcome strategy.
8. May manage a member caseload and/or travel to project sites as appropriate.
9. Perform other duties as assigned.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
- Nursing Diploma or Associate’s Degree in related Health/Nursing field.
Preferred:
- Bachelor’s or Master’s Degree in related Health/Nursing/Social Work/Psychology
Years and Type of Experience Required:
Required:
- Minimum of five years relevant work experience.
Preferred:
- Experience in health services program development, administration, and evaluation.
- Experience working on the community level and with community agencies.
- Experience in managed care, case management and discharge planning Certifications or Licensures (as defined by specific program needs).
Required:
- Active licensed RN, LPN/LVN, LSW or LCSW, LMSW, NP, LPC, PA, CRNP
Preferred:
- Certified Case Manager
Language Skills
Required:
- English
Preferred:
- Bilingual
Functional Competencies
- Working knowledge in a windows environment (MS Word, Excel, Outlook, PowerPoint) to include navigation skills using a mouse and keyboard including use of internet.
- Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
- Ability to use software to conduct data analysis, reporting and sharing of information to solve problems.
- Ability to apply creative/breakthrough methodologies and thinking to the tasks.
- Strong communication skills, written and verbal; articulate, persuasive & influential; systematic and timely.
PHYSICAL RESPONSIBILITIES
The PHYSICAL REQUIREMENTS described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.