Coordinates, monitors, and ensures that appropriate and timely mental health, acute and long-term care services are provided to members across the continuum of care. Assists in coordinating services inclusive of community services to the member. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes. Takes the lead of the care coordination team on all islands, assuring MD orders for medication administration are performed as ordered, and develops educational material for the care coordination team to utilize. Works with the management team of CCS to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Assists CCS psychiatrist as needed by calling in prescriptions, assisting to locate members, assessing members when required and other duties as needed.
REPORTS TO: MEDICAL DIRECTOR, SR
DEPARTMENT: HI-EXECUTIVE STATE
POSITION LOCATION: KAPOLEI, HI 96707
- Conducts face-to-face visits with CCS members for the purpose of assessments, teaching, reviewing and administering ordered medications.
- Develops and provides training to agencies, community partners and staff regarding behavioral health and medical health integration as well as clinical.
- Orders and administers medication as directed by the CCS psychiatrist, and coordinates the ordering and administering of medications by other RN case managers.
- Interacts with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status and to assess the options for care including use of benefits and community resources to update the Care Plan.
- Coordinates community resources and coordinates benefits, regulations, laws and public entitlement programs.
- Maintains HIPAA standards and confidentiality of protected health information; and reports critical incidents and information regarding quality of care issues.
- Utilizes compiled data received from member electronic record to assure that the services being provided meet the member's needs.
- Facilitates member and provider authorization and access to services.
- Seeks to resolve any concerns about care delivery or providers.
- Develops and provides education to staff , community partners and agencies and clinical care for medical conditions as such as Hypertension, diabetic care and dressing changes.
- Develops and provides education to staff, community partners and agencies regarding medications.
- Develops and provides community educational sessions for people with SMI , family of those with SMI and community partners who work with those who may have SMI.
- Participates in IDT meetings.
- Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
- Maintains accurate records of case management activities in the system using clinical guidelines.
- Ensures compliance with all state and federal regulations and guidelines.
- Performs other duties as assigned.
- High School or GED is required
- BSN or MSN Degree is preferred
- 5 years of experience in relevant healthcare with client care coordination responsibilities in Behavior Health (Prefer community experience) is required
- 1 year of experience in current case management as a licensed professional is preferred
- 1 year of experience in working with a Severely Mentally Ill (SMI) population is required
- Experience in a managed care environment is preferred
Licenses and Certifications:
- Ability to work independently
- Ability to multi-task
- Demonstrated time management and priority setting skills
- Demonstrated interpersonal/verbal communication skills
- Ability to create, review and interpret treatment plans
- Ability to effectively present information and respond to questions from families, members, and providers
- Knowledge of healthcare delivery
- Knowledge of community, state and federal laws and resources
- Demonstrated written communication skills
- Demonstrated customer service skills
- Ability to effectively present information and respond to questions from peers and management
- Demonstrated problem solving skills
A license in one of the following is required:
- Licensed Registered Nurse (RN) is required
- Certified Case Manager (CCM) is preferred
- Microsoft Outlook is required
- Microsoft Word is required
- Microsoft Excel is required
- Healthcare Management Systems (Generic) is required