RN - Embedded Care Coordinator

ALLMED STAFFING INC in Plano, TX

  • Industry: Healthcare - Nursing - Others
  • Type: Full Time
position filled
Duties:

(Keep in mind that most of the ECCs are in each office one day a week when not traveling to Physician offices)

  • Prompt office for gaps in care due (Flag EMR/Measure tracking Spreadsheet in paper charts) for ALL lines of business
  • Meet with PCP & office staff contact person (weekly to monthly) to discuss Star ratings, progress, opportunities, missed opportunities, complex members
  • Abstract data from member charts and enter onto Lumeris to meet Star metrics
  • HEDIS: Pull records from PCP chart and email/fax to health plan to close chases forHEDIS audits
  • Closing gaps in care for other lines of business (update spreadsheets and pull records when needed to email/fax to health plan to close Chases/gaps in care 
  • Ensure that members are getting needed referrals and coordination of care to in network providers, especially to get Star measures met (ophthalmologist, Gastroenterologist)
  • Monitor daily admit and DC reports to ensure that members are seen for Post Hospital FU and medication reconciliation within 2 weeks for carve out and 30 days to meet CMS guidelines.
  • Suggest referrals to CM programs as needed that best fit the member’s needs (Medical, Behavioral Health, Respiratory, Aspire, Alegis, DEEP)
  • Monitor Medication adherence & HRM spreadsheets (EAR, one fill, HRM) sent by pharmacy and share/discuss with PCP/Office contact to ensure members are getting refills as needed to meet adherence criteria & not getting refills of HRMs.
  • Monitor Osteoporosis & RA/DMARD spreadsheets and share with PCP/office contact to ensure members receive appropriate medications and/or testing/BMD as needed to meet criteria within the appropriate time frame.
  • Participate in CHT rounds & ICT meetings as needed to discuss needs for identified members. Share information from these meetings with the PCP/office contact and ensure member gets follow up on everything discussed in the meetings. (Referrals, CM programs, Aspire, Alegis, medication problems/changes/interactions) Then follow up with CHT/ICT Team to communicate PCP discussion with outcomes (referrals, medications)
  • Facilitate or assist with other initiatives aimed at improving quality/Star Ratings
Skills:

Extensive knowledge and experience working with electronic medical/health records

Extensive knowledge and experience with Stars Quality Program and/or HEDIS and Part D measures

 

Bilingal (English/Spanish) - not required but a plus

Education:

RN and current unrestricted nursing license in Texas required.


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