Care Coordinator

4 weeks ago

Minneapolis, United States CareerBuilder Full time

ABOUT UCARE
UCare offers Medicare, Medicaid, Individual and Family health plans -- powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
Position Description
As the Care Coordinator - MSHO/MSC+, you will be responsible to coordinate services across the continuum of health care to meet the health and/or social service needs of members in Government plan products as assigned.Coordinate member services with appropriate primary care clinics/providers, care systems, specialists, clinic, county, and UCare personnel to achieve the most appropriate and cost-effective member care to optimize the long-term health of the member.
* Collaborate with treatment providers, county and community agencies, and contracted and non-contracted providers to identify and coordinate provision of health care services for Government plan product members. Appropriately apply care coordination criteria, protocols and procedures.
* Understand and accurately interpret and apply relevant contractual requirements, policies, procedures, and regulations for members which care coordination is a provided service.
* Collaborate with members and/or family members, primary care physicians, clinic staff, providers, and other relevant agencies to assure appropriateness of service that meets member needs and ensures desired outcomes.
* Complete in-person comprehensive assessment of assigned members.Appropriately utilize interpreter services as needed.Identify and monitor member needs, including needed preventive medical care, and significant changes in condition which may warrant early intervention for medical problems.Develop care plans to meet each member's individual needs. Incorporate ethnic and culturally appropriate approaches to care planning.
* Present information on assigned members at assessment conferences and case reviews as appropriate.Enter member information in the clinical documentation system, GuidingCare software.Complete accurate, thorough, and timely required documentation.
* Meet and maintain all established caseload and performance metrics.
* Ensure safe transitions when members move from one setting to another (i.e. being discharged from a hospital or skilled nursing facility).Ensure the plan of care is communicated between the sending and receiving settings for both planned and unplanned transitions.Support members and member families through care transitions between various facilities, acute and/or chronic settings, and community-based living situations including home.
* Use appropriate communication tools per contractual and care model requirements.
* Monitor and report all quality-of-care issues through the appropriate internal or external systems.
* Assist with CMS Star Rating initiatives or HEDIS quality initiatives and project improvement planning as appropriate.
* Attend internal and external meetings, including staff meeting, discharge planning conferences, community meetings.
* Provide back-up coverage for other care coordinators as assigned.
* Must have reliable transportation to travel through designated counties in Minnesota.
* Other projects and duties as assigned.

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