Remote Clinical Coordinator - Care Manager
Job description
** Recruiting in the following UP counties only: Menominee, Gogebic, Baraga, and Ontonagon **
POSITION: Remote Clinical Coordinator — Care Manager
DEPARTMENT: Clinical Services
POSITION SUMMARY:
Performs assigned clinical functions in accordance with Upper Peninsula Health Plan (UPHP) plans, policies, and procedures, and all state and federal accrediting and regulatory standards.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Follows established UPHP policies and procedures, objectives, safety standards, and sensitivity to confidential information.
- Performs all assigned tasks in accordance with UPHP plans, policies and procedures; National Committee for Quality Assurance (NCQA) standards; and all regulatory requirements.
- Required, frequent face-to-face visits with beneficiaries in various care settings including beneficiary homes.
- Assists in the development and maintenance of policies and procedures related to care management in accordance with regulatory requirements and accrediting standards.
- Prepares reports as required.
- Demonstrates knowledge of all clinical Michigan Department of Health and Human Services (MDHHS), Centers for Medicare and Medicaid Services (CMS) and Department of Insurance and Financial Services (DIFS) standards; all applicable NCQA Utilization Management (UM), Quality Improvement (QI), Care Management, and Member's Rights and Responsibility (RR) standards; and Healthcare Effectiveness Data and Information Set (HEDIS®) measures as they relate to clinical functions and the care management program; assumes responsibility for specific NCQA standards as assigned.
- Participates in departmental and interdepartmental process improvements; recommends improvements in clinical processes as opportunities are identified.
- Serves as backup to other team members in their respective areas in demonstrated times of excessive workload and/or benefit time.
- Attends and participates in organizational, departmental, and clinical program meetings as required.
- Assures required licensure continuing education requirements are fulfilled on an annual basis.
- Maintains confidentiality of client data.
- Performs other related duties as assigned or requested.
POSITION QUALIFICATIONS:
Education:
Minimum:
Licensed registered nurse, licensed bachelor of social work, or licensed master of social work
Preferred:
If registered nurse, bachelor’s degree
Requirement:
Licensed in state of Michigan
Experience:
Minimum:
Two (2) years of clinical or health-related experience
Preferred:
Three (3) to five (5) years of clinical managed care experience; experience in care management; experience reviewing statistical data
Required Skills:
- Keyboarding proficiency and working knowledge of MS Office programs Word and Excel
- Excellent human relation and oral/written communication
- Excellent organizational and prioritization abilities
Desired Skills:
- Ability to interpret and analyze data
- Working knowledge of MS Office Access and PowerPoint
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
Physical Requirements:
[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:
- Ability to access departmental files
- Ability to enter and access information from a computer
- Ability to access all areas of the UPHP offices
- Moderate physical effort (lift/carry up to 25 pounds)
- Occasionally lifts supplies/equipment
- Occasional reaching, stooping, bending, kneeling, crouching
- Prolonged periods of sitting
- Occasional prolonged standing
- Manual dexterity and mobility
Working Conditions:
- Works in office conditions, but occasional travel may be required
- Subject to many interruptions
- Exposure to situations requiring exceptional interpersonal skills or high productivity
- Occasionally subjected to irregular hours
Remote Work Requirements:
- Initial on-site/in-person onboarding and training for a minimum of ten (10) consecutive business days at UPHP’s headquarters in Marquette, MI (stipend provided)
- Periodic travel to UPHP’s headquarters for regular training including bi-monthly all staff meetings.
- Private home office required; computer and phone hardware provided
- Personal vehicle required for periodic travel; mileage reimbursement provided at GSA rate
- Localized travel to conduct home visits in residential, community living, and/or nursing home settings
- Internet speed test results in at least 10 Mbps Download / 3 Mbps Upload (Recommended 5 Mbps upload or higher)
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