Clinical Care Coordinator

Sante Health•Fresno, CA

1d•$30 - $36•Onsite

About The Position

We are seeking to fill a key role of Clinical Care Coordinator within our Utilization Management department. This role will be responsible for coordinating care for Santé members post discharge from inpatient and Emergency Department (ED) care and/or with complex medical conditions with co-morbidities, and medication adherence in order to reduce ED utilization and inpatient readmissions and to improve health outcomes.

Requirements

Graduate of an accredited school of nursing.
Minimum of two years of professional nursing experience in an ambulatory clinic or hospital setting.
Must possess an active State Registered RN or LVN license.
Skill in operating a computer and basic office equipment.
Ability to work effectively with others.
Ability to communicate clearly.
Knowledge of professional nursing theory and practice and patient care evaluation.
Skill in applying and modifying the principles, methods and techniques of professional nursing to provide consultative services.
Skill in identifying problems and recommending solutions.
Skill in preparing and maintaining records, writing reports, and responding to correspondence.
Skill in establishing and maintaining effective working relationships with patients, medical.

Responsibilities

Helps develop care management systems to document, monitor, track, and evaluate patient interventions across various organizations, inpatient, and primary care settings.
Works with eligible patients to perform both initial and transitional assessments and develops realistic care management plans.
Incorporates knowledge of nursing care management, levels of care, and utilization management principles to implement high-quality cost-effective care.
Establishes a consistent communication and reporting schedule for periodic contact with the patient's PCP, specialists, community care providers and patients to review patient status and progress toward goals.
Provides patient care coordination intervention and follow-up after interaction with health care system, e.g. inpatient, ED visit, outpatient specialty and in-home care services, etc.
Communicates with social service staff and health care clinicians, about patient's care, utilization, and follow up plans, e.g. ED Care Facilitators, inpatient Care Coordinators, post-acute case managers, social workers, patient navigators, etc.
Attends and presents case reviews at practice meetings, program meetings, and care coordination meetings.
Ensures that appropriate data is documented in structured fields to support information tracking to meet the various reporting requirements.
Acts as clinical resource person for program's quality improvement efforts.
Acts as liaison between members, leadership, and community partners.
Attend required meetings and participate in committees as requested.
Participate in professional development and maintain professional affiliations.
Maintain strictest patient confidentiality.
Maintain strictest confidentiality.
In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested.