The RN- Care Plan Coordinator/Local Care Coordinator, with the support and guidance of the CareFirst Regional Care Coordinator and supervision of a Healthways Medical Director, supports the development and implementation the Medical Home program by working with patients qualified for Care Plans, PCPs and local support teams. The Local Care Coordinator will advocate, guide and intervene on behalf of their patients to ensure successful implementation of the Care Plan. This role acts as the primary interface between the Healthways/CareFirst program and individual primary care physicians and their patients.
· In partnership with CareFirst, develop and maintain strong working relationships with primary care physicians to integrate the Medical Home program into their practices, contributing value to the primary care physician and their patients. Serves as an extension of the PCP office.
· Provide on-site consultation to PCP offices and Care Coordination Team providers related to implementation of the Medical Home model including development and documentation of care plans for individual patients, tracking processes, patient self-management support, implementation of clinical practice guidelines and work process/patient flow improvements. Follow-up with parties as appropriate.
· Assist primary care physicians in the development, documentation and implementation of care plans and delivery of coordinated services for patients identified through this CareFirst program. Principle maintainer of the electronic Care Plan. Utilizes established documentation standards to maintain quality of care plan documentation to include patient progress toward and barriers to achievement of care plan objectives/outcomes. Develop communication and referral mechanisms to assure that there is seamless communication between the CareFirst program, the primary care practice and the Care Coordination Team. Utilize established CareFirst unified communication technology as appropriate.
· In conjunction with CareFirst, develop clinical reports for use in primary care office records, facilitating physician support of patients in behavior change.
· Assist the patient in coordination of any additional tests, images and consults with specialists as deemed appropriate by the PCP in developing the Care Plan. For assigned patients with multiple prescriptions, assess for efficacy and drug interaction/side effects.
· Assist the patient in mitigating issues and removing barriers to care.
· Conduct patient education in support of Standards of Care guidelines and related health issues using the most appropriate modality for the patient.
· Conduct patient satisfaction surveys.
· Healthcare background and current licensure as an RN is required. BSN preferred.
Skills and Experience
- Minimum 3-5 years clinical experience in any of these areas: acute care, home health, physician office management, managed care organization, provider relations, pharmaceutical sales.
- Physician office experience preferred especially working with physicians to make referrals, provide education to patients both telephonically and in person
- Demonstrates ability to be self-directed, highly organized, multi-tasked capable, and proficient in problem solving skills
- Demonstrates exceptional oral, written, and presentation skills.
- Demonstrated success in influencing patients and providers. Outstanding customer service skills and ability to adapt approach to various personalities
- Demonstrates ability to work effectively with all levels of administrative and professional personnel.
- Experience in case management environment preferred, or environment that coordinates care across multiple providers.
- Demonstrates proficiency with data analysis and ability to organize data in support of reporting needs.
- Demonstrates computer competencies to include word processing, spreadsheet, presentation preparation, and data base management. Demonstrated ability to learn customized computer applications.
- Demonstrates ability to proactively identify and assimilate QI/QA processes into practice
- Technical Writing Skills. Ability to extrapolate information from a variety of sources including medical records and create concise records that accurately depict the medical "story" of the member
- Technology expertise with electronic medical record systems, comfort with emails, attachments, utilizing Blackberry and laptop computers.
- Experience with medically oriented care plan documentation
- Comfort with managing multiple tasks and continually re-prioritizing
- Experience working effectively within a matrix organizational design.
- Sales and marketing experience preferred.
- Has valid driver's license and driving record showing no restrictions that would impede ability to travel by automobile.
· 80 % (variable) within assigned region.
This position will be based from a home office which must satisfy all HIPAA requirements
For three decades, Healthways has been dedicated to improving the human condition. Each year, we learn more and do more for the millions of individuals who count on us to make a difference in their health and well-being. Healthways is a global provider of solutions that help employers, health plans and government agencies enhance business performance and reduce healthcare costs. Our mission is to create a healthier world, one person at a time.
Here at Healthways as we continue to make the world a healthier place, we have also created an environment where people choose to do their best work. Our unique culture thrives on mission-driven individuals who exude a high sense of energy and passion in everything that they do. Collaboration and teamwork are an essential part of everyday life for Colleagues who trust and depend on one another to achieve the highest degree of collective success. We are an organization that strives to recruit the best and the brightest individuals who take pride in the statement 'I work for Healthways.'
Healthways, Inc. is an equal employment opportunity employer and is committed to a proactive program of affirmative action and diversity development. Healthways, Inc. will continue to recruit, hire, train, and promote into all job levels without regard to race, religion, gender, marital status, familial status, national origin, age, mental or physical disability, sexual orientation, gender identity, source of income, or veteran status.
Description (We are proud to be an EEO/AA employer M/F/D/V.)