Clinical Coordinator - Care Manager - Medicaid

Upper Peninsula Health Plan•Marquette, MI

About The Position

The Clinical Coordinator - Care Manager provides care management services to multiple member populations, serving as a single point of contact and advocating for members. The role conducts face-to-face visits in a variety of care settings and locations chosen by members; gathers health history; assesses health status, resource use, treatment, goals, and needs; and develops and maintains person-centered care plans. The coordinator monitors and coordinates medical, behavioral health, and community-based services and referrals, identifies barriers to care, and supports transitions between inpatient, outpatient, and community settings. The position works with members, support teams, providers, hospitals, medical equipment companies, home health agencies, and community organizations. It identifies and reports risk management and quality concerns and follows organizational policies, regulatory requirements, and applicable clinical, quality, utilization management, care management, and accreditation standards. The coordinator also participates in meetings and process improvements, maintains confidential records, and provides backup to other team members as needed.

Requirements

Licensed registered nurse.
Licensed in the state of Michigan.
At least two years of clinical or health-related experience as a licensed registered nurse or social worker.
Valid driver’s license with proof of insurance.
Working vehicle.
Keyboarding proficiency and working knowledge of Microsoft Word and Excel.
Strong interpersonal and oral and written communication skills.
Excellent organizational and prioritization abilities.

Nice To Haves

Bachelor of Science in Nursing, limited licensed bachelor of social work, limited licensed master of social work, fully licensed bachelor of social work, or fully licensed master of social work.
Two years of clinical managed care experience or five years of clinical experience as a licensed registered nurse or social worker.
Experience in care management.
Experience reviewing statistical data.
Ability to interpret and analyze data.
Working knowledge of Microsoft Access and PowerPoint.

Responsibilities

Follow UPHP policies and procedures, objectives, safety standards, and confidentiality requirements.
Conduct face-to-face visits with members in healthcare facilities, community settings, and locations where members live, learn, work, play, or worship.
Provide care management services to varied populations, including people with disabilities, pregnant and postpartum members, members with chronic conditions, people eligible for CSHCS, children in foster care, former foster care youth in transitional Medicaid, members within Cell and Gene Therapy, and members receiving mental or behavioral health services.
Serve as a member’s single point of contact and assess health history, home environment, access to community services, and behavioral and health-related social needs.
Assess health status, resource use, treatment and services, prognosis, goals, and treatment and provider options.
Develop and maintain person-centered care plans with objectives, goals, and interventions tailored to member needs.
Monitor and coordinate services and referrals to community organizations, medical care, behavioral health, and other services.
Identify barriers to care and use critical thinking to address member questions and unmet physical, health-related social, and behavioral health needs.
Advocate for members and collaborate with support teams, provider offices, equipment companies, home health agencies, hospital teams, and other parties to support care planning, discharge planning, and transitions of care.
Identify and report risk management and quality concerns to the appropriate body.
Perform assigned tasks in accordance with UPHP plans and procedures, NCQA standards, and regulatory requirements.
Participate in process improvements and help develop and maintain care management policies and procedures.
Maintain knowledge of applicable MDHHS, CMS, DIFS, NCQA, and HEDIS standards and assume responsibility for assigned NCQA standards.
Provide backup to other team members during excessive workload or benefit time.
Attend and participate in organizational, departmental, interdisciplinary care team, and other required clinical program meetings.
Maintain confidentiality of client data and comply with audit, documentation, charting, and timeline requirements.
Perform other related duties as assigned or requested.