Under the general direction of the Care Coordination Supervisor, the Nurse Lead is responsible for providing clinical expertise to staff, administrative support, and high level operational assistance to the department. Participates in the development and implementation strategies and processes to ensure effective Care Coordination department management. The Nurse Lead is expected to perform the duties of Care Coordinator Nurse including, but not limited to coordination of services for an assigned caseload of enrollees.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Assess and manage member needs such as complex medical, psychosocial, cognitive and functional conditions and plans appropriate nursing care plans.
• Provides clinical expertise to clinical and administrative support to staff to ensure meeting team and departmental goals.
• Serve as coordinator/liaison to promote and maintain effective communication with other department/disciplines.
• Participate in the mentoring and training of new and current clinical and administrative staff to ensure competency and standards of practice.
• May delegate tasks or assigns activities to appropriate care team members to implement the plan of care.
• Assist with data referrals such as inpatient census reports, emergency data, and member health surveys for prompt identification and response for member outreach.
• Participates and provides clinical expertise in interdisciplinary team meetings. May facilitate and document meeting minutes from case conferences.
• Assist with timely gathering of data and reports needed for internal and external audits and other special projects as needed. Works closely with Care Coordination Supervisor to ensure validity of data prior to submission.
• May assist the Care Coordination Supervisor with reporting and data trending to monitor and measure the effectiveness of the Care Coordination programs and staffing performance.
• Participates in the development and implementation strategies with the Care Coordination Supervisor to ensure effective department management.
• Serve as an internal resource for department staff demonstrating thorough understanding of the care management system and other applications for the day to day operations. Coordinate resolution with Care Coordination Supervisor or IT department as appropriate.
• Maintain a caseload panel through prompt identification and response to cases appropriate for level of care changes including but not limited to discharge or transfer activities.
• Accepts and performs other duties as assigned.

QUALIFICATIONS

• Current California RN license
• Bachelor’s degree or equivalent preferred
• Excellent verbal and written communication skills
• Bilingual in English and Chinese
• Strong problem solving and critical thinking skills
• Ability to set and change priorities quickly or as the situation warrants
• Able to work independently and as team player
• Proficiency in Word and Excel
• Experience in leadership roles is desirable
• Minimum two years acute inpatient care experienced preferred
• At least one year recent utilization management or case management experience preferred