Job Description

Hiring for an IMMEDIATE NEED. To be considered, please apply and send resume directly to mshenouda@actalentservices.com.

• Fully remote BUT MUST BE LOCAL TO MN due to on site meetings every once in awhile!

Description:

This position is responsible to coordinate services across the continuum of health care to meet the health and/or social service needs of members in Government plan products as assigned. Coordinate member services with appropriate primary care clinics/providers, care systems, specialists, clinic, county, and company personnel to achieve the most appropriate and cost-effective member care to optimize the long-term health of the member.

• Collaborate with treatment providers, county, and community agencies, and contracted and non-contracted providers to identify and coordinate provision of health care services for Government plan product members. Appropriately apply case management criteria, protocols, and procedures.

• Understand and accurately interpret and apply relevant contractual requirements, policies, procedures and regulations for members which care management is a provided service.

• Collaborate with members and/or family members, primary care physicians, clinic staff, providers, and other relevant agencies to assure appropriateness of service that meets member needs and ensures desired outcomes.

• Complete comprehensive assessment of assigned members. Appropriately utilize interpreter services as needed. Identify and monitor member needs, including needed preventive medical care, and significant changes in condition which may warrant early intervention for medical problems. Develop care plans to meet each member\xe2\x80\x99s individual needs. Incorporate ethnic and culturally appropriate approaches to care planning.

• Present information on assigned members at assessment conferences and case reviews as appropriate. Enter member information in the clinical documentation system, Guiding Care software. Complete accurate, thorough and timely required documentation.

• Meet and maintain all established caseload and performance metrics.

• Ensure safe transitions when members move from one setting to another (i.e. being discharged from a hospital or skilled nursing facility). Ensure the plan of care is communicated between the sending and receiving settings for both planned and unplanned transitions. Support members and member families through care transitions between various facilities, acute and/or chronic settings, and community-based living situations including home.

• Use appropriate communication tools per contractual and care model requirements.

• Monitor and report all quality of care issues through the appropriate internal or external systems.

• Assist with CMS Star Rating initiatives or HEDIS quality initiatives and project improvement planning as appropriate.

• Attend internal and external meetings, including staff meeting, discharge planning conferences, community meetings.

• Provide back-up coverage for other care managers as assigned.

Additional Skills & Qualifications:

- B.S. in nursing, B.A. in social work or Registered Nurse with a nursing diploma (3-year program)

- Two years\xe2\x80\x99 experience in care coordination/case management across the continuum of health care (hospital, clinic, nursing home, home care etc.)

- Current and unrestricted Minnesota license as an RN or social worker is required.

- MnCHOICES certified assessor credential in place or with plan to receive assessor credential within 3 months of hire date.

***Willing to consider associate degree in nursing with 5+ Years care coordination exp.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

Actalent is an equal opportunity employer.

About Actalent

Actalent connects passion with purpose. We help visionary companies advance their engineering and science initiatives through access to specialized experts that drive scale, innovation, and speed to market. With a network of almost 30,000 engineering and sciences consultants and more than 4,500 clients across the U.S., Canada, Asia, and Europe, Actalent serves many of the Fortune 500. An operating company of Allegis Group, the global leader in talent solutions, Actalent launched as a new specialized engineering and sciences services and workforce solutions brand in 2021.

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