The Nurse Liaison for Community Care Management is the crucial connector between the Alliance and its network of contracted Community Care Management teams. Under supervision from the Transitions of Care Manager, the Nurse Liaison connects to and oversees teams that target high risk Medi-Cal members with complex needs such as chronic illness and behavioral health conditions leading to acute care utilization, providing an extra layer of support to help them achieve their health goals. Social determinants of health are also identified and prioritized by the teams. The Nurse Liaison is also responsible for coordinating medical, social and or behavioral health care needs for targeted members identified by the Alliance.
Principal responsibilities include:
Primary liaison with Community Care Management teams and participating providers (including office staff)
Work closely with the Alliance Case Management Managers, Medical Directors, Social Workers, Community Health Workers, and other Alliance staff involved in Community Care Management projects to make sure that clinical and administrative support is provided to Community Care Management teams and members in a timely and high quality manner.
Provide support to Community Care Management teams by:
· 1. Identifying which need additional training or help with processes and work-flows and then, with the assistance of Alliance colleagues, providing technical assistance for those teams.
· 2. Providing telephonic, email, or face-to-face coordination and program support to Community Care Management staff to help meet the treatment/care plan goals for their patients.
· 3. Problem solving around authorizations, referrals, prescriptions, timely notification of acute care utilization and transfer of clinical notes and discharge summaries.
Audit and review Community Care Management processes, documents, and performance measures for completion and quality. This includes reviewing and giving feedback on their comprehensive risk assessments and their health action plans.
Provide and document care coordination and care management activities for specific high risk members identified by Alliance. This will include face-to-face encounters. Organize and participate in clinical case conferences and meetings with Community Based Care Management case managers, providers, Alameda County Health Care Services staff, and/or Alliance staff in order to support effective care coordination and comprehensive care.
With the help of the Project Manager, Case Management Manager and Medical Director, help organize and facilitate monthly meetings for the Community Care Management teams for them to discuss challenges and best practices. Help identify and bring in local experts for education/technical assistance when gaps in knowledge are identified.
Demonstrate knowledge of managed care, including coverage and benefits, authorizations, and grievance and appeals. Educate and answer inquiries from participants, patients, and members and/or their family members about benefits, services, eligibility and referrals with a positive and professional approach, promoting participant, patient, and member satisfaction and retention.
ESSENTIAL FUNCTIONS OF THE JOB
· Work with Community Care Management teams to develop appropriate member assessments and care plans.
· Serve as a clinical resource to Alliance and Community Care Management staff, and members, as needed.
· Develop relationships with appropriate county and community agencies to help support members and Community Care Mangement teams
· Provide direct care coordination and care management services to a small number of high risk members identified by the Alliance. Maintain case management records.
· Communicate with members and providers to ensure coordination of services for members.
· Perform writing, administration, analysis, and report preparation.
· May help train staff.
· Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
· Constant and close visual work at desk or computer.
· Constant sitting and working at desk.
· Constant data entry using keyboard and/or mouse.
· Extensive typing required.
· Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
· Travel to member homes, Care Facilities and/or Hospitals as needed. Travel to meetings as needed.
· Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
· Frequent walking and standing.
· Occasional driving of automobiles.
EDUCATION OR TRAINING EQUIVALENT TO:
· Active California Registered Nurse License, Nurse Practitioner
· Have a cleared TB test prior to or within seven days of hire.
· Current CPR and first aid card prior to or within six months of hire is preferred.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· Minimum three years healthcare experience, preferably in a health plan setting and a working knowledge of medical and insurance terminology preferred.
· Minimum one year experience in care delivery or coordination in an outpatient clinic, office, home care or inpatient setting including care plan development, care coordination and discharge planning preferred
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Knowledge of and experience with the underserved population preferred
· Knowledge of acute and chronic medical and behavioral health related topics required.
· Knowledge of and experience with local community resources preferred
· Experience in a medical/public health setting preferred
· Ability to prioritize case load
· Ability to make thoughtful decisions and exercise sound judgment.
· Ability to analyze and synthesize UM and care coordination information.
· Experience with case management preferred. Masters in Case Management will be considered in lieu of healthcare or clinical experience
· Experience with planning, implementing, and evaluating clinical and disease prevention programs preferred.
· Background in population-based community health assessment and interventions.
· Ability to work effectively in a multidisciplinary team
· Ability to communicate effectively, both verbally and in writing.
· Possess flexibility and creativity.
· Familiarity with programmatic and clinical research strategies in managed care settings preferred.
· Experience in use of various computer system software as well as Windows, Microsoft Word, Excel, Outlook, and PowerPoint.
$77,710 - $116,570/annually