Care Coordinator I - Health Alliance Plan - Troy

GENERAL SUMMARY:

This position is responsible for case management services provided to the membership of HAP Midwest Heath Plan MI Health Link within the framework of the Annual Case Management Plan.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Perform comprehensive clinical and diagnostic assessments for members meeting institutional level of care.
• Clinical and diagnostic evaluation and review of chronic condition information related to complex medical needs, behavioral health needs, activities of daily living (ADL’s) and instrumental activities of daily living (IADL’s) for long term supports and waivers.
• Long term services and supports clinical and diagnostic assessments and care planning for members with complex and chronic conditions including performing and arranging for waiver services and personal care assistance.
• Refer members to community resources for the appropriate agencies and organizations to enhance and supplement services for the member. Examples: Community Mental Health, Area Agency on Aging, Local Health Departments, Meals on Wheels and Transportation.
• Initiates and implements an individual plan of care with attainable goals in conjunction with the member, health care providers, and community agencies. Modifies the plan of care through monitoring and re-evaluation to accommodate changes in treatment or progress for all assigned members.
• Care coordination contacts include telephonic and face-to-face interaction with members in their homes, inpatient and outpatient settings, and institutional settings.
• Documents the plan of care in accordance with HAP Midwest Health Plan Policies, NCQA guidelines and Medicare/Medicaid requirements within the Case Management Program.
• Performs on-going evaluation of quality and cost effectiveness of Case Management Services.
• Documents care in accordance with Midwest Health Plan Policies.
• Maintains statistical data, reports and logs as required.
• Works with the Concurrent Review Nurse on evaluations of hospitalized members in need of discharge planning, transitions of care, medication reconciliation, and case management.
• Works with the Referral Coordinator to ensure the member receives the correct and cost effective DME.
• Interacts with Vendors, Specialists and Primary Care Physicians to authorize and coordinate services for members.
• Presents medically complex questionable cases to the Case manager/Care Coordinator RN and/or Medical Director for review.
• Assures maintenance and sharing of records, reports and assures HIPPA compliance.
• Assists the Manager of Health Services with Case Management Program planning, development, implementation and evaluation.
• Attends identified Plan Committee and Staff Meetings.
• Other duties as assigned.