Clinical Coordinator - Care Manager

DEPARTMENT: Clinical Services ## RATE: $29.72 per hour, with potential for additional compensation based on qualifications. ## ESSENTIAL DUTIES AND RESPONSIBILITIES: 1. Follows established UPHP policies and procedures, objectives, safety standards, and sensitivity to confidential information. 2. Performs face-to-face visits with members in various care settings including acute care hospitals, outpatient clinics, Federally Qualified Health Centers, Rural Health Clinics, urgent care centers, rehabilitation facilities, nursing homes and other long term care facilities, home health settings, mobile clinics and provider offices. Face-to-face visits may also occur where a member lives, learns, works, plays or worships which may include but is not limited to the member's home, school, workplace, faith based organization, community center, shelter, library or food pantry. 3. Provides Care Management services for multiple populations including but not limited to the following: disabled populations, pregnant and postpartum members, those members with chronic conditions, members enrolled in or eligible for Children's Special Health Care Services (CSHCS), children in foster care, former foster care youth in Foster Care Transitional Medicaid, members within Cell and Gene Therapy (CGT), members engaged with mental or behavioral health services. 4. Serves as a member's single point of contact; gathers vital health history and monitors the member's home environment, access to community-based services, and behavioral and health related social needs through assessments. 5. Assesses members' current health status, resource utilization, past and present treatment plan and services, prognosis, short and long-term goals, and treatment and provider options. Develops and maintains person centered care plans based upon assessment with specific objectives, goals, and interventions designed to meet member needs. 6. Monitors and coordinates delivery of services and referrals made to community-based organizations, medical care, behavioral health and other services to support the members' overall care management plan. 7. Identifies barriers to care to help inform care management and care planning activities. 8. Applies critical thinking skills to address member questions and unmet physical, health related social needs, and behavioral health care needs. 9. Works as a member advocate and collaborates with support teams, medical care offices, medical equipment companies, home health agencies, hospital care teams, and other parties to ensure appropriate discharge plan, care plan, and coordination of inpatient, outpatient, and community setting changes in condition. 10. Identifies related risk management and quality concerns and reports these scenarios to the appropriate body. 11. Performs all assigned tasks in accordance with UPHP plans, policies, and procedures; National Committee for Quality Assurance (NCQA) standards; and all regulatory requirements. 12. Participates in departmental and interdepartmental process improvements, recommending improvements as opportunities are identified, and assists in the development and maintenance of policies and procedures related to care management in accordance with regulatory requirements and accrediting standards. 13. 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