Care Support RN - MCHD

Job Description:

General Statement of Duties

The MCHD Westside CareSupport (CS) Registered Nurse (RN) is responsible for supporting the MCHD Primary Care Team by providing care management/case management services for CareOregon members receiving primary care at Westside Clinic. A key focus of the position is addressing member^s exceptional needs care coordination (ENCC) requirements as mandated by DMAP for the phase II population, and acting as a resource to the clinic for complex CareOregon members requiring extensive clinical support. Key partners in this process are the member and relevant family/caregivers, and the member^s primary care provider (PCP).

Statement of Off-Site CareSupport Duties

 

In addition to the above described duties, this RN is also responsible for traveling to area hospitals, Skilled Nursing Facilities, and/or homes of members, using his or her own vehicle. The objectives of this expanded role are: (1) the coordination of care and services if the member is being discharged from a facility to their home environment, and (2) assessment of and integration of the home environmental strengths and barriers into the overall care plan for the member. In this key role the RN must have exceptional interpersonal and communication skills, as multiple members of the healthcare team are organized to provide seamless transitions and fully coordinated care for the member.

Essential Position Functions

 

 

Care management for individual members

 

 

• Support the medical management plan provided by the member^s primary and specialty providers
• Using nursing clinical judgment, assess overall risk of member in conjunction with primary provider - physical, behavioral, social and environmental. Assess medical stability and adherence with prescribed treatment plan.
• Respond to inquiries, service requests or CareSupport assistance requests
• Respond to data base profiles which identify members considered high risk for medical care resource utilization
• Respond to referrals from UM RNs (concurrent review and referral/authorization) and CareOregon Behavioral Health staff
• Collect all relevant information in order to determine medical need and plan course of action
• Develop plan of action by clearly defining the goal of intervention
• Acknowledge member^s right to choice of treatment or refusal of treatment
• Implement the plan in coordination with all relevant parties
• Evaluate the effectiveness of the plan and determine follow-up needed
• Collaborate with community providers and their staff, state workers, business partners, vendors, agencies and other relevant parties
• Plan, participate and as needed, facilitate, care conferences for medically complex members and others as deemed appropriate
• Assess appropriateness of member discharges by Primary Care Provider (PCP) and discuss any concerns with the clinic

 

Utilization Management

 

 

• Recommend resource utilization based on the Oregon Health Plan (OHP) benefit package
• Creatively utilize available resources in the most cost effective manner
• Involve the Chief Medical Officer for resource needs that exceed the OHP benefit package for situations that appear to warrant an exception
• Process service appeal requests according to unit protocols and standards

 

ENCC Requirements (Phase II population) For Identified Needs

 

 

• Assist members to ensure timely access to providers and capitated services
• Coordinate with providers to ensure consideration is given to unique needs in treatment planning
• Assist providers with coordination of capitated services and discharge planning
• Aid with coordinating community support and social services systems linkage with medical care systems, as deemed necessary and appropriate

 

Off-site Transition Care Support

 

 

• High degree of self-motivation
• Excellent organizational skills
• Creative problem-solving ability
• Empathetic and compassionate
• Non-judgmental
• Ability to analyze member/family readiness to adapt to post-facility realities
• Skillful coaching of member^s self- management abilities

 

Essential Department and Organizational Functions

 

 

• Screen situations to determine if OMAP disenrollment criteria applies and request disenrollment according to the unit protocols
• Forward relevant information of members requiring special intervention to UM RN or CareOregon Behavioral Health staff
• Makes referrals to established community programs as deemed appropriate
• Provide training to new employees on specific tasks related to their job responsibilities
• Follow ENCC policy and procedure
• Follow established departmental policies and procedures
• Report to work as scheduled
• Perform other duties and projects as assigned

 

Job Requirements:

Knowledge, skills and abilities required

 

 

• Knowledge of the Oregon Health Plan and Medicare A and B benefit packages
• Knowledge of OMAP rules and regulations pertaining to utilization management, disenrollment criteria and ENCC services
• Knowledge of community resources
• Knowledge of Department of Human Services (DHS) branch offices and role of the state case workers
• Knowledge of OHP eligibility categories
• Knowledge of ICD-9, CPT and HCPCS codes
• Knowledge of drug formularies
• Ability to establish collaborate relationships
• Knowledge of the principles of managed care
• Ability to use critical thinking skills in problem solving
• Ability to read, write and verbally communicate effectively
• Excellent customer service skills
• Ability to work in an environment with diverse individuals and groups
• Ability to manage multiple tasks and to remain flexible in a dynamic work environment
• Ability to work autonomously and to effectively set priorities
• Basic word processing skills

 

Education and/or Experience

 

Current Oregon RN license required, home health experience and a current driver^s license required as well as dependable transportation, with evidence of insurance. Additionally, case ,management and care coordination experience with a Health Plan and experience working with patients who may be mentally ill, homeless or chemically dependent is preferred. Preference may be given to individuals who have disease management/population management experience and experience with the Oregon Health Plan benefit administration.

Working Conditions

 

This individual will experience receiving a high volume of telephone calls, completing worksheets, and using computer programs to either obtain or record information. These functions will occur on an on-going basis and will need to be performed simultaneously. Given the multiple tasks and deadlines, this individual must be able to organize their work and remain focused under stressful conditions. This individual will be expected to possess a high degree of initiative and motivation along with the ability to effectively collaborate and plan with coworkers and others. In addition, this individual will be in contact with a variety of professional and technical staff and must be customer service oriented and able to function under potentially tight time lines. This position will require an individual to sit for long periods of time. Travel, including overnight stay, may be required to attend care conferences and other relevant meetings.

Off-site Working Conditions

 

This individual will work remotely from the Care Oregon office, making daily visits at specified hospitals and in member homes. The ability to maintain focus no matter the environment in which this RN finds him/herself is of paramount importance as well as the ability to meet deadlines for assuring delivery of care/services. Attention to detail is vital as accurate member data is tracked in databases and QNXT systems. All documentation will be entered into a laptop computer, and communication with the on-site care support team is via cell phone.

Equipment Used

 

Laptop and cell phone while off-site. Personal computer and coding manuals, Medical Terminology books, and other standard office equipment for recording, storing and presenting information on site.

Job Responsibilities:

To Apply

 

Please reference Job Code HR-MM MCR and email a cover letter and resume to resumes@careoregon.org or fax to 503.416.3668 or mail to CareOregon, HR-MM MCR, 315 SW 5th, Suite 900, Portland Oregon 97204. Position may close at any time. EEO