Job Title: Clinical Coordinator – RN Care Team Lead
Department: Medicaid Waiver Program
Reports to: Medicaid Waiver Program Director
Schedule: Monday – Friday, with occasional nonstandard hours and overnight travel
Under the direction of the Medicaid Waiver Program Director this exempt employee directs the clinical management of LTSS care team duties and assessments. Coordinates efforts to address clinical factors impacting health and wellbeing of LTSS case management clients. Participates in the performance of Agency level determination of need and level of care reviews to include client medication review and other assessments required throughout client’s program participation. Coordinates with care team for assignment of cases based on acuity. Acts in a supervisory role for clinical team when capacity dictates more than one team member. Performs all related tasks to insure departmental and individual compliance with established policies, procedures and standards. Establishes and maintains reports and records of activities. Performs other duties as assigned.
Essential Duties and Responsibilities:
- Manages day-to-day operations of clinical related activities within the department
- Manages a Team of Case Management staff, to include but are not limited to TA Waiver Case Manager, ACTW Case Manager and GCL Transition Coordinator.
- Assists Program Director in development of improvement of case management processes, methods and data collection through web-based software platform data to ensure quality, efficiency, and measurement of outcomes.
- Reviews reports of critical incidents related to health issues in order to determine improvement areas if relevant.
- Assists in development and preparation of reports.
- Interprets and analyze healthcare data.
- Serves as contractor liaison addressing client skilled nursing needs.
- Collaborates with the Program Director in developing case management training modules to strengthen staff ability to comply with standards.
- Provides training and program updates to case managers.
- Provides insight and direction to management on quality and compliance with policies and procedures.
- Promotes effective and efficient utilization of agency resources.
- Perform, and/or participate in, annual process improvement sessions in order to improve quality, efficiency and effectiveness of processes.
Clinical Case Review
- Applies clinical judgement and knowledge for reviews of client records.
- Reviews and interprets medicals for level of care determinations.
- Reviews annual redeterminations for ongoing need and level of care.
- Identifies any inconsistencies or discrepancies in medical evaluations.
- Forwards inconsistencies or discrepancies to case managers for follow up with physicians to obtain clarification, modification or correction as needed.
- Documents reports of discrepancies for follow up.
- Collects, organizes, updates and maintains information related to client file reviews.
- Documents and reports findings related to client file reviews.
- Utilizes medication review tool in review of medications logged by case manager to identify discrepancies and errors.
- Documents medication discrepancies by individual and by other characteristics as determined for quality improvement purposes.
- Reports medication discrepancies to case manager for follow up with physician.
- Follows up with case manager regarding previously reported medication discrepancies.
- Documents and reports findings related to reviews.
Record Keeping and Reporting
- Documents client assessment reviews.
- Documents quantity of work performed by established categories.
- Completes records and reports of discrepancies in records for quality improvement purposes.
- Develops, prepares and analyzes management reports about productivity and accuracy related to review activities.
- Records activities and time spent using appropriate codes and forms; ensures time is correctly credited to specific clients and categories.
- Prepares reports of work activity, findings and other reports as needed.
- Develops and maintains general knowledge of the Medicaid Waiver program and of any other programs for which job duties are performed.
- Participate in various education and or training activities as required.
- Conducts seminars and education programs to publicize and educate the community about agency programs.
- Participates in health fairs.
- Performs other duties as assigned.
Education / Experience
- Registered Nurse with current, active Alabama license and 2 years of professional experience.
Special Skill Requirements (*Can be acquired on the job):
- Knowledge of medications, including dosing and other medication characteristics.
- Knowledge of medical terminology.
- Knowledge of basic health needs and common cognitive issues of the elderly population.
- Knowledge of common medical conditions affecting the elderly population.
- Knowledge of behavioral health conditions and treatment options.
- Ability to write effective and clear correspondence, maintain records, and document procedures and interviews thoroughly and clearly.
- Ability to follow oral and written instructions.
- Ability to exercise judgment in evaluating difficult situations.
- Ability to organize work schedule and work independently.
- Ability to write policies and procedures and process descriptions.
- Ability to use Microsoft Office products for correspondence, reporting and analysis.*
- Ability to interpret and analyze healthcare data.
- Ability to use, review and document in case management software.*
The work environment involves everyday risks or discomforts which require normal safety precautions typical of such places as offices, meeting and training rooms, libraries, and residences or commercial vehicles, e.g., use of safe work practices with office equipment, avoidance of trips and falls, observance of fire regulations and traffic signals, etc. The work area is adequately lighted, heated, cooled and ventilated.
The work is sedentary. Typically, the employee may sit comfortably to do the work. However, there will be some walking; standing; bending; carrying of light items such as papers, books, small parts; driving an automobile, etc. No special or extreme physical demands are required to perform the work.
All resumes should be sent to firstname.lastname@example.org.