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Diversion Team Healthcare Coordinator RN

- Fulltime   Diversion Team Healthcare Coordinator RN
The primary purpose of this position is to assure the State’s Diversion Referral and Screening (DRS) project is implemented successfully to increase the probability of “direct” diversions for the Transitions to Community Living Initiative (TCLI) for those members at risk for entry into Adult Care Homes (ACH).  The DRS project will allow Local Management Entities/Managed Care Organizations (LME/MCOs) to interact with individuals at risk for entry into ACHs earlier on in the admission/discharge process.  The Healthcare Coordinator serves as the central medical resource on the Diversion Team and is responsible for liaising behavioral care with medical care for members referred the Diversion Team.  This role is essential for bringing together a comprehensive view of whole person care, particularly as it relates to Cardinal members with complex behavioral and medical healthcare needs.  In addition, the Healthcare Coordinator will work collaboratively with the internal Clinical and Medical Departments to develop and implement Cardinal’s interface with community stakeholders.  The Transition Healthcare Coordinator will collaborate regularly with TCL partners to develop more successful outcomes for TCL members. This position spends a considerable amount of time in the field and completes required documentation/paperwork at an office location or in the employee’s home (as applicable).
Essential Functions
The Healthcare Coordinator is responsible for (though not limited to):
  • Reviews Diversion Screenings and other clinical documentation for medical items of concern/importance and convey orally or in writing these concerns to the Diversion Team
  • Facilitates and provides oversight of clinical and medical case reviews in compliance with accepted standards of member care and industry best practices
  • Reviews Clinical Assessments and other clinical documents to assure that medical and integrated care needs are addressed
  • Participates in multidisciplinary case conferences to provide direction and clinical recommendations to front line staff managing complex and high risk cases
  • Provides clinical administrative support as well as clinical expertise to meet member and staff needs
  • Functions as the liaison for Personal Care Services (PCS) with physician practices and hospital case management / other referral sources as needed
  • Identifies medical and/or behavioral barriers to situation/complaint resolution and follows-up with the appropriate resources or leadership to address timely and effectively
  • Evaluates progress toward attainment of outcomes through documentation review, interdisciplinary team meetings and/or case conference
  • Facilitates the integration of physical and behavioral healthcare, including: detection of service needs, linkage to primary care and collaboration with CCNC and in-home nursing (and other entities) as appropriate
  • Provides customized, evidence-based member/teammate education as needed in a variety of areas including but not limited to: chronic disease management, chronic comorbidities, and physical health integration
  • Develops relationships with community stakeholders in an attempt to streamline service provision to members
  • Collaborates with Care Coordination leadership, Quality Management, Corporate Training, and Data Sciences in determining methods for improving comprehensive member care (including physical, emotional, social, and economic factors) in an effort to improve Transition Healthcare Coordination service offerings to TCL members
  • Provides behavioral-specialized clinical knowledge to the physical health setting to support the primary care and other providers
  • Creates, implements and supports TCL Team with medical trainings to share critical research findings and best practices
  • Collaborates directly and frequently with TCL Leadership Team and participates in TCL Leadership Team Meetings as needed
  • Develop collaborative working relationships with Transition Care Coordinators and Team Leads
  • Provide direct assistance and/or participate in consumer home visits when requested.


Knowledge, Skills and Abilities:  
  • Employee must be able to analyze data across factors and time periods to identify and report trends/patterns
  • Knowledge of and ability to effectively facilitate quality enhancement efforts, particularly as it relates to clinical outcomes
  • Ability to establish and maintain positive and effective working relationships with others both within the company and community stakeholders.
  • Demonstrates initiative and problem-solving capabilities, ability to work independently and use sound clinical judgement.
  • Functional computer skills, experience with Microsoft Suite of applications
  • Excellent written and verbal communication skills.
  • Telephonic clinical management experience and/or managed care experience preferred.
  • Project management or program management preferred.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Work Experience
Education:
  • Nursing Degree (RN) and have two years post-licensure experience in a primary healthcare setting
  • Requires a current and active North Carolina Nursing License
Experience:
  • Experience working in the behavioral health field preferred
Valid Driver’s License Required: Yes Travel Type: None Required Percentage:   None
Language: Read Write Speak