[Remote] Remote Community Based Clinical Coordinator - Care Manager - Luce County, MI

Note: The job is a remote job and is open to candidates in USA. Upper Peninsula Health Plan (UPHP) is a healthcare organization seeking a Remote Community Based Clinical Coordinator - Care Manager. The role involves performing clinical functions and care management duties to assess, plan, and coordinate medical services for members, ensuring quality and cost-effective care across various settings.ResponsibilitiesFollows established UPHP policies and procedures, objectives, safety standards, and sensitivity to confidential informationPerforms all assigned tasks in accordance with UPHP plans, policies, and procedures; National Committee for Quality Assurance (NCQA) standards; and all regulatory requirementsPerforms required, frequent in-person visits with members in various care settings including member homes and nursing facilities. Serves as a member’s single point of contact; gathers vital health history and monitors the member’s home environment, access to community-based services, and behavioral and health related social needsAssesses members’ current health status, resource utilization, past and present treatment plan and services, prognosis, short and long-term goals, and treatment and provider options. Develops plans of care based upon assessment with specific objectives, goals, and interventions designed to meet member needsMonitors delivery of services and referrals made to community-based organizations, medical care, and other services to support the members’ overall care management planApplies critical thinking skills to address member questions and unmet physical, health related social needs, and behavioral health care needsWorks as a member advocate and collaborates with support teams, medical care offices, medical equipment companies, home health agencies, hospital care teams, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long-term care servicesIdentifies related risk management and quality concerns and reports these scenarios to the appropriate bodyParticipates in departmental and interdepartmental process improvements, recommending improvements as opportunities are identified, and assists in the development and maintenance of policies and procedures related to care management in accordance with regulatory requirements and accrediting standardsDemonstrates knowledge of all clinical Michigan Department of Health and Human Services (MDHHS), Centers for Medicare and Medicaid Services (CMS), and Department of Insurance and Financial Services (DIFS) standards; all applicable NCQA Utilization Management (UM), Quality Improvement (QI), Care Management, and Member's Rights and Responsibility (RR) standards; and Healthcare Effectiveness Data and Information Set (HEDIS®) measures as they relate to clinical functions and the care management program; assumes responsibility for specific NCQA standards as assignedServes as backup to other team members in their respective areas in demonstrated times of excessive workload and/or benefit timeAttends and participates in organizational, departmental, Interdisciplinary Care Team (ICT) meetings, and other clinical program meetings as requiredMaintains confidentiality of client dataPerforms other related duties as assigned or requestedSkillsLicensed registered nurseLicensed in state of MichiganTwo (2) years of clinical or health-related experience as a licensed registered nurse or social workerValid Driver's License with proof of insuranceWorking vehicleKeyboarding proficiency and working knowledge of MS Office programs Word and ExcelExcellent human relation and oral/written communicationExcellent organizational and prioritization abilitiesBachelor of science in nursing, limited licensed bachelor of social work, limited licensed master of social work, fully licensed bachelor of social work, or fully licensed master of social workTwo (2) years of clinical managed care experience or five (5) years of clinical experience as a licensed registered nurse or social workerExperience in care managementExperience reviewing statistical dataAbility to interpret and analyze dataWorking knowledge of MS Office Access and PowerPointBenefitsStipend providedComputer and phone hardware providedMileage reimbursement provided at GSA rateCompany OverviewMission Statement The mission of UPHP is to be an innovative health plan managing the care of our members in the Upper Peninsula guiding them to quality, cost-effective care through our network of providers improving the overall health of the communities we serve. It was founded in 1998, and is headquartered in Marquette, Michigan, USA, with a workforce of 51-200 employees. Its website is https://www.uphp.com/.