Care Coordination Nurse

The Care Coordination Nurse conducts telephonic calls to assist with care coordination and health education for identified health plan members. The nurse will assure that members have access to quality, cost-effective health care and assists in the assessment, coordination, teaching aimed at self-management, and monitoring activities to facilitate member care. The nurse will collaborate and facilitate care with medical service providers including but not limited to physicians, home health providers, medical equipment vendors, and community resources.

• Identifies potential candidates effectively by utilizing various CCHP data sources, such as daily inpatient census, internal data, self-referrals, provider referrals, and utilization management staff.
• Conduct member outreach in response to referrals to assist with member issues or concerns.
• Assess and manage member needs such as complex medical, psychosocial, cognitive and functional conditions.
• Identify early risk factors and conduct ongoing phone assessments when necessary.
• Assist with member Health Risk Assessment (HRA) surveys to administer and contact as needed.
• Review members’ HRA survey responses for both Commercial and the Senior Select (Special Needs Plan) population.
• Develop a comprehensive care plan with appropriate interventions consistent with CCHP policy guidelines and Medicare/Medicaid requirements within the care management system.
• Gather input from the member and/or responsible parties in the development of the care plan.
• Modifies the plan of care through monitoring and re-evaluation to accommodate changes in treatment or progress for assigned members.
• Document all activities in the CCHP’s care management system to allow for continuity of care.
• Performs post discharge follow up, case management, and disease management duties through promoting healthy lifestyles, closing gaps in care, reducing unnecessary ER utilization and hospital readmissions.
• Provide members with appropriate education to enhance their knowledge related to health or lifestyle management.
• Identifies for medically complex members and consult with others of the interdisciplinary team.
• Work collaboratively with others of the interdisciplinary team in assessing, planning, and providing services to members.
• Assist in coordinating communication between doctor’s office, clinics, hospitals, member/families, home health agencies, vendors, and CCHP staff.
• Utilizes evidence-based guidelines such as Interqual Guidelines and other tools such as HealthWise.
• 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.
• Monitors & reports outcomes of the member weekly/ monthly as requested.
• Participates in team meetings.
• Accepts and performs other duties as assigned.

CORE COMPETENCIES

• Must possess and consistently demonstrate the following competencies:
• Management – Makes the best use of available time and resources. Acknowledges and corrects mistakes. Shows up to work on time, and follows instructions, policies, and procedures. Meets productivity standards, deadlines, and work schedules. Prioritizes tasks by importance and deadline. Displays an ongoing commitment to learning and self-improvement.  Desiring and making an effort to acquire new knowledge or skills for work.
• Leadership Effectiveness – Leads by example and sets standards for professional behavior. Helps those in need of assistance, regardless of rank. Offers help when needed.  Identifies what needs to be done and takes action before being asked or required. Recognizes situations that warrant initiative and moves forward without hesitation.  Displays a positive attitude about the work to be done, co-workers, customers, management, and policies. Conveys positive attitude in the process of change.
• Decision Making and Judgment – Coordinates ideas and resources to achieve goals. Identifies, collects, and organizes data for analysis and decision-making. Shows insight into the root-causes of problems. Generates a range of solutions and courses of action with benefits, costs, and risks associated with each. Examines data to grasp issues, draw conclusions, and solve problems.
• Teamwork – Conveying confidence in co-workers’ ability to be successful, especially with new and challenging tasks. Earns others’ trust and respect through consistent honesty and professionalism in all interactions. Builds constructive working relationships characterized by a high level of acceptance, cooperation, and mutual respect.  Maintains an open, approachable manner, and treats others fairly and respectfully.  Preserves others’ self-confidence and dignity, and shows regard for their opinions. Promotes cooperation and commitment within a team to achieve goals and deliverables.
• Continuous Improvement – Adapting to and working with a variety of situations, individuals, and groups. Demonstrates openness to new organizational structures, procedures, and technology.  Openness to different and new ways of doing things.  Willingness to modify one’s way of doing things. Diligently attends to details and pursues quality in accomplishing tasks.  Develops fresh ideas that provide solutions to all types of workplace challenges.
• Communication – Keeps manager informed about progress and   problems.   Ensures that others involved in a project or effort are kept informed and developments and plans. Allows others to speak without unnecessarily interrupting them.  Gives the speaker undivided attention and appears interested in the message (e.g., maintains eye contact, nods). Gets along and interacts positively with co-workers and others.  Asks and answers questions that enhance the clarity, quality, and reliability of information.
• Work Product Quality – Adheres to all workplace and trade safety laws, regulations, standards, and practices.  Displays openness to different or new ways of doing things and sees multiple perspectives. Responds positively to change, embracing and using new practices or values to accomplish goals and solve problems. Respects and maintains confidentiality. Tells the truth and is honest in all dealings.  Encourages and supports others at work.  Focuses on results and desired outcomes and how best to achieve them in order to get the job done.  Willingly puts in extra time and effort in crisis situations; goes the “extra mile” to ensure the goal is met. Defining tasks and milestones to achieve objectives, while ensuring the optimal use of resources to achieve those objectives.
• Customer Service – Builds and maintains customer satisfaction with the products and services offered by CCHP.  Meeting and exceeding customer needs while cultivating relationships that secure commitment and trust.  Seeks customer feedback and ensures needs have been fully met. Be positive when interacting with customers. Delivers products and services when and where the customer needs them.  Engages customer in identifying issues, options, and desired outcomes. Develops a clear picture of the needs and best options from the client/customers’ perspective.  Remains committed to helping the client long after initial solutions have been applied. Follows up to make sure desired outcomes are realized. Acts proactively, recognizing important trends that will affect customers. Communicates those trends so clients can better prepare to meet new challenges. Develops new services and service models in line with those needs. Anticipates and recognizes the concerns of others, even if those concerns are not openly expressed. Provides excellent services to internal and external customers.

• Current California RN license or California LVN license
• Bachelor’s degree or equivalent preferred
• Excellent verbal and written communication skills
• Bilingual in English and Chinese (Cantonese)
• 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
• Ability to maintain high volume workload without compromising quality
• Minimum two years acute inpatient care experienced preferred
• At least one-year recent utilization management or case management experience

• Able to lift up to 30 pounds
• Use proper body mechanics when handling equipment
• Standing, walking and moving 50% of the day

Complies with Chinese Hospital Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.

Starting at $33.99 – $50.95.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.