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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.
• 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
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.
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: www.carefirst.com/careers
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