Care Coordinator IV-RN

Overview

Presbyterian is seeking a Care Coordinator IV.  The Care Coordinator facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes

 

• This is a Full Time position - Exempt: Yes
• Job is based at Albuquerque, NM
• Remote work from home: this job is intended to be conducting in the state of New Mexico.
• Work hours: Weekday Schedule Monday-Friday

 

Ideal Candidate:

• RN
• Must have a valid driver license, clean driving record and able to travel locally.
• Experience in utilization management,  home care, community health, long term care or occupational health required.

Qualifications

• Masters degree & 4 years of exp, Bachelors degree and 8 yrs of exp, Associates degree and 9 years of exp, 12 years of exp may be utilized in lieu of other education and experience reqs.
• Proficiency in Microsoft Word, Excel and Outlook required.
• Experience in analyzing trends based on decision support systems.
• Business management skills to include, but not limited to, cost/benefit analysis,negotiation, and cost containment.
• Knowledge of referral coordination to community & private/public resources.

Responsibilities

• Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across thecontinuum. Collaborates with the Interdisciplinary Care Plan Team which may include member, caregivers, members legal representative, physician, care providers, andancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term careservices.
• Conducts in depth health risk assessment and/or comprehensive needs assessment which include, but not limited to psycho-social, physical, medical, behavioral,environmental, and financial parameters.
• Provides care coordination to members with chronic or complex conditions which require intensive interventions and oversight include multiple, clinical, social and communityresources. Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. 
• Develops and communicates plan for authorization of services, and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to homecare, back up plans, community based services).
• Conducts face to face home visits, as required,
• Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes; collects clinical path variance data that indicatespotential areas for improvement of case and services provided; works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
• Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Generates reports in accordance with care coordination goals.

Benefits

About Presbyterian Healthcare Services Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Maximum Offer for this position is up to

USD $49.26/Hr.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.