CareFirst Careers

PCMH Local Care Coordinator - Washington, DC Region 16

This job posting is no longer active

Resp & Qualifications

Local Care Coordinator (LCC), with the support and guidance of the CareFirst Regional Care Director (RCD), supports the implementation of the CareFirst Patient-Centered Medical Home (PCMH) program by working with members who are attributed to a Primary Care Physician as well as members seeing a specialist practitioner and/or who do not have a Primary Care Physician (unattributed) who are benefit eligible and meet the selection criteria for Care Coordination. The LCCs works with Primary Care Physicians (PCPs), Specialty Care Providers and regional support teams. 

The Local Care Coordinator will advocate, guide and intervene on behalf of their members to ensure successful implementation of the Care Plan while providing Complex Case Management through the duration of the Care Plan. The LCC acts as the primary interface between the CareFirst program and individual primary care providers (PCPs), Specialist and their patients (members).

Under the general supervision of a Regional Care Director the incumbent’s accountabilities may include, but are not limited to, the following:

• Develop and maintain strong working relationships with PCPs, Specialists and other clinicians to integrate the PCMH program into their practices.
• Serves as an extension of the PCP office for PCPs who participate in the PCMH Program as well as specialists.

• Provide on-site consultation to PCP and Specialists’ offices and Care Coordination Team providers related to implementation of the PCMH model including development and documentation of Care Plans for individual members, inclusive of tracking processes, member self-management support, implementation of clinical practice guidelines and work process/patient flow improvements.  Follow-up with parties as appropriate.

• Collaborate with PCPs, Members and Specialty Providers in the development, documentation and implementation of Care Plans and delivery of coordinated services for members identified through this CareFirst program.

• Facilitates and monitors the transition of care which involves moving the member from one healthcare practitioner and setting to another as their healthcare needs change, utilizing TCCI programs as appropriate to meet the member’s needs. Implements and oversees the agreed upon plan of care in conjunction with TCCI partners and reviews all cases.  Coordinates member follow-up post discharge for applicable transitions.

• Maintain the electronic Care Plan.

• Utilize established documentation standards to maintain quality of Care Plan documentation to include member progress toward their established state of being and barriers to achievement of Care Plan objectives/outcomes.

• Develop communication and referral mechanisms to assure that there is seamless communication between PCMH, PCPs, Specialists and the Care Coordination Team. 

• Abides by PCMH Program Description and Guidelines.

• In conjunction with Regional Care Directors and PCMH Practice Consultants, develops clinical reports for use in PCP office, facilitating PCP support of members in behavior change.

• Assist the member in coordination of any additional tests, images and consults with specialists as deemed appropriate by the PCP or Specialist. For selected members with multiple prescriptions, perform a comprehensive medication reconciliation (CMR) at the onset of the Care Plan, as well as every thirty days during the life of the Care Plan, or when any medication is changed, added or deleted, assessing for efficacy and drug interaction/side effects.

• Identifies appropriate TCCI program partners and other healthcare providers/vendors as well as Community Resources.  Refers and follows-up on referrals and results.

• Assesses the member’s ongoing care needs and progress towards goals throughout the case duration and makes revisions as needed to address changes in the member’s condition, lack of response to the care plan, preference changes, and transitions in care settings. Coordinates plan of care with the provider with goals of member stabilization, decreased admissions and medication management.

• Direct the PCP or specialist practitioner to the Program Consultant or RCD when he/she identifies an opportunity for education or additional learning needs surrounding the Program that are outside of his/her understanding.

• Coordinate patient education in support of standards of care guidelines and related health issues using the most appropriate modality for the member.

• Facilitate the completion of member satisfaction surveys, Patient Activation Measures (PAM) and Post-PAM graduation.

• Verbally or physically connect with each member every week.

  • Maintain member encounter rates of 100%; and
  • Provide effective coordination of care.

• Completes mandatory training
• Actively participates in team huddles and contributes to the clinical learning
• Keeps current on clinical knowledge via self-directed learning
• Effectively escalates issues and/or system issues to supervisor
• Other duties as assigned

Required Education/Experience/Skills/Abilities:

  • Healthcare background and current licensure as an RN is required.  BSN preferred.
  • 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.
  • Demonstrates ability to be self-directed, highly organized, multi-tasked capable, and proficient in problem solving skills
  • Demonstrates exceptional oral, written, and presentation skills.
  • Demonstrates 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.
  • 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 quality improvement processes into practice.
  • Ability to extrapolate information from a variety of sources including medical records to create concise records that accurately depict the medical “story” of the member
  • Maximize all technology inclusive of iCentric, Skype, Microsoft Word, Microsoft Excel, Microsoft Outlook, laptop computers, iPhone, and all other relevant CareFirst unified communication technologies. 
  • Experience with medically oriented care plan documentation
  • Comfort with managing multiple tasks and continually re-prioritizing
  • Experience working effectively within a matrix organizational design.
  • Has valid driver's license and driving record showing no restrictions that would impede ability to travel by automobile.
  • Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.  Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.   Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Travel requirement: 50 - 80% (variable) by own automobile within assigned region and to attend corporate meetings throughout the Baltimore/Washington metropolitan regions.

This position will be based from a home office which must satisfy all HIPAA requirements.

BSN preferred.


Department: CareCo: CareCoordination

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply:

Closing Date

Please apply before: 6/30/18

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

Learn more about Medical Management