University of Massachusetts Medical School

Care Coordinator,UMP

Minimum Salary US-MA-North Quincy
Job Location 4 months ago(10/21/2020 4:32 PM)
Requisition Number
2020-35550
# of Openings
1
Posted Date
Day
Shift
Exempt

Overview

GENERAL SUMMARY OF POSITION:

Under the direction of the Manager for the Hospital Utilization Management Program (UMP) or designee, the Care Coordinator is responsible for the coordination of an array of service needs of MassHealth Members to facilitate the discharge planning from hospitals, rehab facilities and other 24 hour levels of care in conjunction with other service providers. The Care Coordinator -works with other units in OCA, other MassHealth Programs including but not limited to the Office of Long Term Care, The Office of Acute and Ambulatory Care and The Office of Behavioral Health as well as some of their vendors.  The Care Coordinator also coordinates and collaborates with other state agencies and multiple external entities including hospitals and rehab facilities, advocacy groups and other community based service providers to ensure an integrated approach to the care of the MassHealth member. The Care Coordinator is also responsible for the social service needs of members related to transplantation and other medical service which cannot be provided in-state

Responsibilities

MAJOR RESPONSIBILITIES:

 

  • Complete understanding of the MassHealth (MH) Acute and Chronic Hospital regulations, the Transportation regulation, the All Provider Regulations and the Eligibility Regulations
  • Understanding of the rules that pertain to disclosure and Personal Health Information (PHI)
  • Refer appropriate cases to the MH Enhanced Coordination of Benefits (ECOB) unit to ensure all funding sources are utilized
  • Serve as the MH liaison for cases managers/discharge planners at specific acute care hospitals and rehab facilities that the Care Coordinator is assigned to cover
  • Assist the hospital case manager with discharge planning of MH members by serving as a resource on MH regulations, eligibility, provide information about appropriate facilities, or information about services available thru other MH programs
  • Attend case conferences at the facilities with members, families, providers, state agencies and other collaterals for the purpose of treatment planning, care coordination and discharge planning to assist UM nurse reviewers with challenging disposition planning at acute hospitals, rehab facilities as well as skilled nursing facilities
  • Conduct regular onsite visits to assigned facilities to enhance the liaison/collaboration role of the care coordinator.  Proactively identify complex situations and assisting the staff, members and families by providing information and engaging in creative problem solving.  Attend facility discharge conferences as needed
  • Represent MH at meetings with outside agencies such as attending Med/Psych Rounds with PCC Plan and OBH staff with the carve-out vendor for behavioral health.  Assist with service provision for the member that is outside the scope of responsibility for the vendor as well as collaborate with the vendor on those complex cases that require close coordination of multiple services
  • Provide follow-up Care Coordination services by telephone or on site visits to MH members in the community who have recently been discharged, the objective being to ensure that appropriate services are in place that allow the member to remain in the community
  • Maintain case files
  • Work with Analytics Unit within in OCA to develop reports that could be used to identify trends associated with these members and any other information that could be used to provide information to MassHealth Program staff regarding: the service needs of these members; what needs to be developed or enhanced in the delivery system to meet these needs; more efficient and effective community based alternatives to 24 hour levels of care etc
  • Assist in the development of policy and procedures related to Care Coordination services
  • Collect information for program initiatives, maintain list of agencies, facilities, homeless shelters, etc in which MH members could receive care or assistance
  • Coordinate appropriate, cost effective transportation for members receiving approved medical care out of state; coordinate with prior authorization physicians, the out of state facilities, transportation vendors, and MH operations and finance staff.
  • Perform other job related duties as assigned or requested.

ADDITIONAL RESPONSIBILITIES

  • Ensure that members eligible for care management, care coordination, or care integration services through the Behavioral Health vendor, the PCMHI, or other initiatives are appropriate referred to and managed by those programs
  • Work with the OCA analysis unit to identify members whose patterns of utilization suggest that there may be opportunities to improve care quality and efficiency through care management intervention.

Qualifications

REQUIRED QUALIFICATIONS:

  • Current license (RN) to practice in the Commonwealth of Massachusetts
  • A minimum of five years of case management experience working in a health care or community setting
  • Certification in Care Management desirable
  • Strong knowledge of community based service programs
  • Ability to establish productive working relationships at all level of the organization
  • Ability to interpret appropriate regulations
  • Ability to work independently and collaboratively
  • Experience with Windows based systems, Word, and Excel
  • Occasional travel within Massachusetts may be required.

Additional Information

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