RN, CARE COORDINATOR-IRIS-18454

WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.

The RN Care Coordinator for the IRIS program in this position will work with members as a health coach to assist them through the navigation of the health care system and to promote effective health care. The Care Coordinator is also responsible for analyzing clinical data and implementing severity adjusted actions for the purpose of reducing potential medical errors, promoting interventions that adhere to evidence-based clinical care and presenting cost reduction strategies for accounts. Essential duties include, but are not limited to: Responsible to evaluate and develop clinical program components to optimize care management strategies and goals and implements clinical programs and products that support product strategy. Analyzes data to identify and stratify potential medical errors and quality of care issues. Presents and educates members and providers on identified Care Considerations and consults on corrective action indicated. Identifies providers who may require sanctions or intervention of medical director. Provides real-time education on potential care issues for both providers and members. Makes appropriate referrals to Advanced Care Management, Disease Management or other appropriate medical management program. Recommends products or programs to reduce cost for accounts. Coordinates and follows up on members referred to other internal and external programs, and tracks and documents outcomes achieved. Identifies clinical issues for escalation.. May assist in marketing program and implementing new accounts. Performs other duties as assigned. Hours are 8:00 a.m. to 5:00 p.m., Mon.-Fri.  Other flexible schedules available including four 10-hour days per week.



Qualified candidates will have an active, unrestricted Indiana RN license, BSN preferred. 5 years relevant clinical experience preferably in disease management, med/surg or case management. Experience with patient education and physician consultation preferred. Good PC skills and working knowledge of various software and Internet applications required. Current knowledge of evidence-based clinical guidelines across a wide variety of conditions and age groups. Requires excellent oral and written communication skills, understanding cost and quality issues . Ability to influence provider and member health adherence behavior. Ability to manage multiple priorities under time constraints, and excellent organizational skills. 


 


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