RN Care Coordinator Per Diem Position
2 days ago
We are seeking a highly skilled Registered Nurse to join our team as a Care Coordinator. In this role, you will work closely with our primary care team to coordinate care services for our members. As a Care Coordinator, you will be responsible for establishing and maintaining communication with members, families, and caregivers to ensure seamless coordination of benefits and services.
Key Responsibilities- Establish and maintain communication with members, families, and caregivers to ensure seamless coordination of benefits and services.
- Review member status and assist in achieving progress toward goals; adjust the individualized care plan as necessary.
- Perform administrative functions for or on behalf of the primary care provider and/or care team.
- Participate in program effectiveness analysis and planning.
- Perform member visits and rounding as established and directed by the care team.
- Communicate status of member with care team for evaluation and individualized care plan updates.
- Communicate with member, family, and caregivers of the community and other members of the interprofessional team with each member visit.
- Assist with other clinical and quality responsibilities for member, such as gaps in care.
- Attend meetings on behalf of the care team and communicate updates to the individualized care plan with the interprofessional team.
- Provide clinical educational programs for facility staff.
- Communicate information on behalf of the care team to the member, family, and caregivers at the facility.
- Coordinate and collaborate with the health plan/client.
- Assist with advance care planning.
- Perform collection of data, including functional status, BMI, vital signs, urine test for proteinuria, IFOBT specimen collection, and other clinical data. Results are entered into the electronic medical record and reviewed by the care team.
- Perform care coordination activities within the facility to ensure member needs are met, including member external provider appointments, therapy needs, durable medical equipment, and transportation.
- Stay abreast of all Model of Care (MOC), documentation, and policy updates communicated via email, newsletters, and team meetings.
- Maintain an understanding of and utilize clinical resources independently, including but not limited to Resource1, iCoreCodeGenius, Sparq, Learnsource, and other Optum internal sites.
- Maintain confidential health information according to state and federal regulations, including HIPAA.
- Current unrestricted Registered Nurse license in Oregon.
- 2+ years of RN experience.
- Experience with using an electronic medical records system.
- Basic Microsoft Office skills with the ability to navigate in a Windows environment.
- Valid driver's license and the ability to travel locally 75% of the time.
- BSN.
- 1+ years of case management experience.
- Home Health experience.
- Experience working in post-acute care, such as long-term care or hospice, and/or case management experience as an RN.
- Experience working with the geriatric population.
- Familiarity with the long-term care business environment.
- Proven excellent communication and customer service skills.
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