Remote Community Based Clinical Coordinator - Care Manager

Upper Peninsula Health Plan•Marquette, MI

2d•Remote

About The Position

The Remote Community Based Clinical Coordinator - Care Manager performs clinical functions in accordance with Upper Peninsula Health Plan (UPHP) policies and procedures and applicable state and federal regulatory and accrediting standards. The role provides care management for selected 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 member health status, services, treatment plans, goals, and needs; develops individualized plans of care; monitors services and community referrals; advocates for members; and coordinates with providers and support organizations. The role also participates in quality and process improvement, meetings, and other assigned clinical program duties. The position is remote but requires an initial minimum of ten consecutive business days of on-site onboarding and training at UPHP headquarters in Marquette, Michigan, periodic headquarters travel for training and bi-monthly all-staff meetings, and localized travel for member home and facility visits. A private home office and personal vehicle are required. UPHP provides computer and phone hardware, a stipend for initial onboarding travel, and mileage reimbursement at the GSA rate.

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 and personal vehicle for travel.
Keyboarding proficiency and working knowledge of Microsoft Word and Excel.
Excellent human relations and oral and written communication skills.
Excellent organizational and prioritization abilities.
Ability to access departmental files and all areas of UPHP offices, and to enter and access information using a computer.
Ability to perform the physical functions described, including lifting or carrying up to 25 pounds, occasional reaching, stooping, bending, kneeling, or crouching, prolonged sitting, occasional prolonged standing, and manual dexterity and mobility.
Private home office required.

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, procedures, objectives, safety standards, confidentiality practices, NCQA standards, and applicable regulatory requirements.
Conduct frequent in-person visits with members in various care settings, including member homes and nursing facilities, and serve as each member’s single point of contact.
Gather vital health history and monitor members’ home environments, access to community-based services, 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 specific objectives, goals, and interventions based on member assessments.
Monitor the delivery of services and referrals to community-based organizations, medical care, and other services supporting 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, medical equipment companies, home health agencies, hospital care teams, and other parties to coordinate discharge plans, care plans, acute care, and long-term care services.
Identify related risk-management and quality concerns and report them to the appropriate body.
Participate in departmental and interdepartmental process improvements, recommend improvements, and assist with developing and maintaining care-management policies and procedures.
Maintain knowledge of applicable MDHHS, CMS, DIFS, NCQA, and HEDIS standards and measures, and assume responsibility for assigned NCQA standards.
Provide backup for other team members during excessive workloads or benefit time.
Attend and participate in organizational, departmental, Interdisciplinary Care Team, and other clinical program meetings as required.
Maintain confidentiality of client data.
Perform other related duties as assigned or requested.