Remote Community Based Clinical Coordinator - Care Manager

Upper Peninsula Health Plan•Marquette, MI

1d•Remote

About The Position

The Community Based Clinical Coordinator performs clinical functions in accordance with Upper Peninsula Health Plan (UPHP) policies and procedures and applicable state, federal, accrediting, and regulatory standards. The role provides care management for select members by assessing, planning, and coordinating medical and supporting services across the continuum of care to promote quality, cost-effective care. The coordinator serves as a member’s single point of contact and conducts frequent in-person visits in settings such as members’ homes and nursing facilities. The position assesses members’ health status, care needs, goals, treatment options, home environment, and access to community services; develops and monitors individualized plans of care; and collaborates with providers, support teams, agencies, and other parties to coordinate services and support appropriate care transitions. This is a remote position that requires a private home office, local travel for member visits, periodic travel to UPHP’s Marquette headquarters, and initial on-site onboarding and training for at least ten consecutive business days. Computer and phone hardware are provided, and mileage for travel is reimbursed at the GSA rate.

Requirements

Minimum education: Licensed registered nurse.
Must be 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 and personal vehicle required for travel.
Keyboarding proficiency and working knowledge of Microsoft Word and Excel.
Strong human-relations and oral and written communication skills.
Excellent organizational and prioritization abilities.
Ability to perform essential physical functions, including accessing files and office areas, entering and accessing computer information, lifting or carrying up to 25 pounds, and occasional reaching, stooping, bending, kneeling, or crouching.
Ability to sit for prolonged periods and occasionally stand for prolonged periods; manual dexterity and mobility.
Private home office required.
Must complete initial on-site, in-person onboarding and training at UPHP headquarters in Marquette, Michigan, for at least ten consecutive business days.
Must travel periodically to UPHP headquarters for training, including bi-monthly all-staff meetings, and locally for member home visits.

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.
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, procedures, objectives, safety standards, confidentiality expectations, and applicable regulatory and accrediting requirements.
Conduct frequent in-person member visits in care settings such as homes and nursing facilities; serve as a member’s single point of contact and gather health history and information about the home environment, community-service access, and behavioral and health-related social needs.
Assess members’ health status, resource utilization, treatment plans and services, prognosis, goals, and treatment and provider options.
Develop plans of care with objectives, goals, and interventions based on member assessments.
Monitor services and referrals to community-based organizations, medical care, and other supports included in members’ care plans.
Use critical thinking to address members’ questions and unmet physical, behavioral health, and health-related social needs.
Advocate for members and collaborate with support teams, medical offices, equipment companies, home health agencies, hospital teams, and other parties to coordinate care, discharge plans, and acute and long-term care services.
Identify and report risk management and quality concerns to the appropriate body.
Participate in process-improvement work and recommend improvements; assist with developing and maintaining care-management policies and procedures.
Maintain knowledge of applicable MDHHS, CMS, DIFS, NCQA, and HEDIS standards and measures, and take responsibility for assigned NCQA standards.
Provide backup to other team members during excessive workloads or benefit time.
Attend and participate in organizational, departmental, Interdisciplinary Care Team, and other required clinical program meetings.
Maintain confidentiality of client data.
Perform other related duties as assigned or requested.