Clinical Outreach Specialist - RN

3 weeks ago
Job ID
2017-3022
# of Openings
1
Category
Clinical Staff
Type
Full Time Regular

Overview

Clinical Outreach Specialist - RN

 

Using a member-centered approach, the Clinical Outreach Specialist engages and coaches' members through innovative engagement techniques. The Clinical Outreach Specialist seeks to understand the current state of the member’s health. This critical role conducts telephonic outreach to provide health education, set mutual goals and realistic, evidenced-based health interventions that focus on self-management and disease literacy, then works with the member on progress towards goals. This position will also communicate lab results, ascertain health status and identify risk for escalation of symptoms to avoid unnecessary hospital utilization for health plan members, including those with chronic conditions or who were recently discharged from the hospital.  

This team member may also provides information to member on local community resources for ongoing support to achieve goals.

Social Media_clinical contact center for iCIMS

Responsibilities

  • Engages members into the Matrix programs by conducting telephonic outreach and identifying health benefits to participation.
  • Works with member to understand the current state of their health and to set goals and realistic interventions, identifies barriers to achieving goals, coache's member towards self-management and understanding their chronic conditions, the impact to their lifestyle and how to avoid complications.
  • Provides comprehensive condition-specific self-management training, education and coaching.
  • Reviews and communicates medical records and pertinent test results to members, PCPs, field clinicians and Medical Director.
  • Ensures all necessary lab results are reported properly and accurately to the primary care provider and/or the member in a timely manner according to established policies.
  • Provides local community resource pool to refer members who need ongoing assistance to achieve health goals.
  • Facilitates transition back to Health Plan Case Management programs, as needed, for members with frequent healthcare acute care utilization or who need ongoing health support.
  • Conducts telephonic outreach to members in the Post Acute Transition program to complete risk stratification, care management, care plan to avoid unnecessary readmissions.
  • Actively participates in weekly Care Conferences, documents follow up actions and ensures they are complete.
  • Acts as liaison between the Care Center, field clinicians, primary care providers and health plans.
  • Assists with member follow up actions, including fulfillment of service requests identified by field clinicians.
  • Documents all member/provider contact, follow up actions and resolution of issues into clinical documentation system.
  • Complies with established criteria for response time and deadlines related to communication with health plans, members and primary care providers.
  • Provides clinical leadership, guidance, educational opportunities, and support for all non-clinical staff.
  • Builds and nurtures professional and effective relationships with all members of the member’s health care team, both internal and external.
  • Works with fellow staff to identify and problem solve all barriers to a highly successful program.
  • Participates in all mandatory compliance and other training programs, seeks guidance for compliance-related concerns and adheres to all applicable laws, regulations and Matrix Medical Network policies and procedures.
  •  Abides by all Matrix Medical Network privacy and confidentiality policies when accessing or communicating member information.
  • Demonstrates excellent customer service with his/her actions being consistent with Matrix’ Mission, Vision, and Core Values.
  • May assist in orienting and coaching new members to the team.
  • May assist in maintaining or updating department manuals and/or policies.
  • Other duties as assigned.

Qualifications

Educational Requirements:

 

  • Current unrestricted licensure to practice as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the state(s) to which the candidate is assigned.
  • Maintains nursing license in good standing.
  •  

Required Skills and Abilities:

 

  • Ability to provide telephonic support and education to members in a way they are able to understand
  • Ability to use diverse communication techniques to communicate complex concepts to members and caregivers
  • Exceptional telephonic communication skills with health plan members or caregivers
  • Ability to build rapport and maintain positive, pleasant demeanor with all levels of internal and external contacts
  • Maintain professionalism with members, caregivers, and other health care team members at all times  
  • Consistent and effective follow-up skills
  • Effective written communication skills
  • Ability to multi-task, coordinate, and prioritize activities in a rapidly changing environment
  • Proven time management and organizational skills
  • Professional email etiquette
  • Being comfortable with the phone, email, and fax as the main means of communication.
  • Ability to effectively work within a group dynamic
  • Possess unquestionable personal and professional ethics, in concert with company standards
  • Ability to work independently, coordinating, and assimilating multiple pieces of data to accomplish required tasks
  • Possess unquestionable personal and professional ethics
  • Ability to read, write and speak effectively in English
  • Ability to work in diverse, multi-cultural environment and be respectful to health plan members’ cultural and socioeconomic characteristics
  • Proficiency in Microsoft Office (Word, Outlook, Excel) and the internet
  • Ability to assess when escalation of items is necessary and escalate to the appropriate resource

Experience:

  • Minimum five (5) years of nursing experience
  • Minimum two (2) years case management experience preferred
  • Home care experience preferred
  • Telephone triage experience preferred
  • Experience with Medicare/Medicaid beneficiaries preferred
  • Must have experience working with the Microsoft Office Suite (Outlook, Word, Excel)
  •  

Supervisory Responsibility: No supervisory responsibilities

 

Travel Requirements: No travel necessary

 

Work Conditions: General office environment

 

The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of the position.

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