RN- Care Coordinator Transplant/ESRD

5 days ago

Champaign, United States Carle Health Full time

Overview

  • The Care Coordinator for transplants/ESRD (End stage renal disease) RN Coordinator, acts as the lead facilitator of the multidisciplinary case management team and is a Registered Nurse (RN). The focus of the role is managing and directing high-risk, high-cost members to appropriate resources, services and programs. This position specifically works with transplant/ESRD members. In order to accomplish they evaluate and plan for comprehensive coordination of care and health services to manage members across the continuum. They partner and collaborate with the integrated team and partners in order to provide seamless exchange of information between providers, members, and caregivers with the ultimate outcome to improve quality, reduce costs and enhance member experience. In addition to care coordination, responsibilities include, but are not limited to Utilization Management functions that involve coordinating assigned utilization benefits, quoting benefits, and ensuring procedures meet all medical criteria.

Qualifications

License/Certifications:
Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)

Education:
College Diploma: Nursing (Required)

Other Knowledge/Skills:
Nursing
Responsibilities

Coordinates and manages complex medical cases and health care needs across the continuum of care for both Medicare Advantage and Commercial members. Specific focus on members with transplant and End Stage Renal Disease (ESRD) diagnoses.
Conducts member assessments, identifies gaps and interventions, and coordinates ongoing care with physician and integrated team.
Develops initial and quarterly personalized care plan with member and the primary care provider (PCP).
Maintains continuity of longitudinal documentation appropriate for continuity of care.
Helps the member create / coordinate a support team in their local community to help them manage their long-term health status independently.
Tracks the top coordination tasks needed by most complex cases and when they are completed will be graduating the member to monitoring status and / or other programs.
Lead facilitator of the multidisciplinary care coordinator team managing and directing high-risk, high-cost members to appropriate resources, services and programs.
Care Coordinators will focus on 1% commercial and 5% Medicare targeted/prioritized complex cases, subject to further analysis.
Creates care plan summary and communicates / discusses with the PCP and member.
Assigned to embedded locations or geographic areas / service areas.
Know the Utilization Management (UM) and Care Coordination (CC) work flows.
Build working relationships with providers for transplant concerns.
Willing to learn the system for contracts and single case agreements for different insurance plans.
Quote benefits related to transplants to members based on their plan.
Perform On Call via a rotation schedule for the weekends to meet the regulatory guidelines for transplant members.
About Us

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

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