Care Coordination Nurse

•  Identifies potential candidates effectively by utilizing various CCHP data sources,
  such as daily inpatient census, internal data, self-referrals, provider referrals, and
  utilization management staff.
• Conducts member outreach in response to referrals to assist with member health
  needs or concerns by phone, mail or any other forms of communication to promote
  program engagement.
• Assesses and manages complex medical, psychosocial, cognitive and functional
  conditions.
• Identifies early risk factors and conducts ongoing phone assessments when
  necessary.
• Assists the member in completing the Health Risk Assessment (HRA) surveys and
  coordinates with the primary care physician to meet the individual’s care needs.
• Reviews members’ HRA survey responses for Commercial and the Senior Select
  (Special Needs Plan) population, checks them against the medical record for
  accuracy, and then discusses the responses with the member during the outreach
  call. After the review, the nurse documents findings, identifies care gaps or health
  risks, and makes appropriate referrals or care coordination as needed.
• Develops a comprehensive care plan with appropriate interventions consistent with
  CCHP policy guidelines and Medicare/Medicaid requirements within the care
  management system.
• Gathers input from the member and/or responsible parties in the development of the
  care plan.
• Modifies the plan of care through monitoring and re-evaluation to accommodate
  changes in treatment or progress for assigned members.
• Documents all activities in CCHP’s care management system to allow for continuity
  of care.
• Performs post discharge follow up, case management, and disease management
  duties through promoting healthy lifestyles, closing gaps in care, reducing
  unnecessary ER utilization and hospital readmissions.
• Provides members with appropriate education to enhance their knowledge related to
  health or lifestyle management.
• Identifies medically complex members and consults with others on the
  interdisciplinary team.
• Works collaboratively with others on the interdisciplinary team in assessing,
  planning, and providing services to members.
• Assists in coordinating communication between doctor’s office, clinics, hospitals,
  member/families, home health agencies, vendors, and CCHP staff.
• Utilizes evidence-based guidelines such as InterQual Guidelines and to identify
  member’s needs and provide care coordination support.
• Collaborates with the Utilization Management (UM) department and assists with UM
  activities to help members navigate the approval process, optimize quality of care,
  and promote cost-effective practices. Maintains a caseload panel through prompt
  identification and response to cases appropriate for level of care changes including
  discharge or transfer activities.
• Monitors & reports outcomes of the member weekly/ monthly as requested.
• Participates in team meetings.
• Accepts and performs other duties as assigned.

• Current California RN license
• Bachelor’s degree or equivalent preferred
• Excellent verbal and written communication skills
• Bilingual in English and Chinese (Cantonese)
• Ability to set and change priorities quickly or as the situation warrants
• Able to work independently and as team player
• Proficiency in Word and Excel
• Ability to maintain high volume workload without compromising quality
• Minimum two years acute inpatient care experienced preferred
• At least one-year recent utilization management or case management experience
  preferred

• Able to lift up to 30 pounds
• Use proper body mechanics when handling equipment
• Standing, walking and moving 50% of the day.

Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.