Network Coordinator

Job Title: Network Coordinator or Manager/ Clinical Care Management

The Coordinator / Manager oversees the day to day operations of the clinical care coordination team (clinical care coordinators and clerical support) for the [name of network]. The Coordinator is accountable for scheduling, day to day supervision, and the performance appraisal process for clinical care coordination staff. The Coordinator establishes collaborative relationships with physicians to ensure that patients are cared for in the most critically appropriate setting. The Coordinator is accountable to achieving effective and measurable clinical, financial, and functional outcomes. Other responsibilities include but are not limited to ensuring the collection of service-related data and evaluation of processes and outcomes to facilitate quality improvement. The Coordinator promote a safe environment, performs all job responsibilities in a safe manner, and maintains clinical and professional competencies.

II. Responsible To

The network coordinator is responsible to the network Clinical Director, the Executive Board / Steering Committee and the Network Medical Management Committee. In addition, the network coordinator is responsible to the Program Director at the program office in Raleigh.

III. Principal Work Relationships

• Network Clinical Director
• Access II and III Program Director, Medical Director and QI staff
• Participating physician's in the network.
• Local project and case management staff.
• Community agencies – DSS, hospital, health department, PCPs, specialists, and/or other community organizations.
• Other network coordinators.

IV. Essential Functions Defined

Functions as the day-to-day manager for clinical care management with Medicaid enrollees.

a) Ensures adequate coverage of each area.
b) Coordinates/facilitates patient progression throughout the continuum.
c) Utilization management and quality screening for patients.
d) Supervises, coaches and mentors staff to ensure the achievement of departmental goals and objectives.
e) Promotes effective communication with physicians, nurses, and other members of the interdisciplinary care team to effect timely and appropriate patient management.
f) Functions as a role model and ensures that clinical care coordination staff work collaboratively and maintain active communication with physicians, nursing, and other members of the interdisciplinary care team to effect timely and appropriate patient management.

Schedules staff, supervises staff performance, and conducts performance appraisals of the clinical care management staff and clerical support.

a) Collaborates with the care management team to assist patients with resource management. Communicates, as needed, with patients to ensure understanding of appropriate guidelines.
b) Communicates and collaborates with the interdisciplinary team.
c) Performs utilization management and quality screening for patients, as needed.
d) Directs effective delivery of services with the interdisciplinary team through patient care and/or disease management conferences. Collaborates and/or mentors members of the health care team regarding the plan of care or variance in plan implementation or outcome and documents findings in patient's record and the Access II and III system.
e) Actively participates in the initiation, development and maintenance of population-based disease management programs, facilitating collaboration and consensus of interdisciplinary teams throughout the process.
f) Collects and analyzes patient care, fiscal data, disease management variances, analysis data, and outcome data relevant to the target case type to promote quality improvement.
g) Analyzes and evaluates the effect of clinical care coordination on quality outcomes, fiscal parameters, customer satisfaction, and system operations and implements strategies to resolve system, performance, and patient variances.
h) Identifies and plans strategies to reduce resource consumption within the high-risk case management population. Works in collaboration with physicians and appropriate health care providers for revisions, as needed.
i) Formulates, implements, and evaluates strategies for specialized staff education as it relates to patient care, case management, and/or disease management.
j) Leads interdisciplinary groups in designing and implementing innovative alternative solutions that address system problems and/or patient care issues occurring across the full continuum of care.
k) Oversees / coordinates the work of the clinical care coordinators and administrative assistants.

Responsible for ensuring that the network supports the mission, goals and values of the [name of network] and the Access II and III program.

a) Regularly reviews plan objectives to determine compatibility with the network's mission, goals and values. Recommends appropriate modifications based on reviews.
b) Responsible for the coordination and development of a vision, strategic plan and operational plan with which to operate the network.
c) Leads development team and oversees the framework for network's strategic plan.
d) Coordinates and oversees committee structure to include appropriate members of organizations and the community.
e) Implements strategies to foster collaborative community relationships.
f) Works collaboratively with other network coordinators.

Accountable for the assessment, planning, implementation, and evaluation of plan services to enrollees.

a) Assesses enrollee's needs in the community through various channels.
b) Recommends, coordinates and collaborates the development of programs to meet enrollee needs based on their assessments and input from the community.
c) Assists in implementing programs and evaluating the success of each program to ensure quality and efficiency, while avoiding duplication of internal and external efforts.
d) Utilizes principles of “rapid cycle quality improvement” in program development.

Collaborates with the Clinical Director, local Health Director, local Hospital, local medical societies, and other community organizations and agencies to assure coordination of plan services.

a) Maintains regular communication with the Clinical Director and clinical leaders in participating practices.
b) Collaborates with all project partners to support continuum of care and enhanced enrollee outreach.
c) Maintains regular contact with community leaders and organizations serving enrollees to enhance the effectiveness of program initiatives.
d) Participates and presents, as necessary, on various boards, committees and work groups as program representative.

Accountable for overall administrative operations.

a) Provides overall coordination of program development.
b) Manages program budget, fiscal affairs, allocation of resources, and financial transactions.
c) Monitors program activities, assuring that contract deliverables are met.
d) Monitors contractual services and reports inconsistencies to the Board.
e) Develops a high level of proficiency in the software programs utilized by project staff.
f) Assists in the resolution of recipient complaints.

V. Knowledge, Skills and Abilities

• Understand principles and operations of the NC Medicaid Program and the Access II and III Program.
• Understand the principles of quality improvement in the health care setting.
• Strong organizational, leadership and planning skills.
• Excellence in verbal and written communication.
• Ability to work with a variety of health care professionals in the hospital, academic and community settings.
• Experienced in facilitation and group process.
• Ability to prioritize disease and care management activities.
• An understanding of the Medicaid population.
• Knowledge on the best processes and materials to provide education and outreach services.
• Understand the importance of evidence-based clinical guidelines in quality improvement.
• Understand population management and stratification and prioritization of care management activities.
• Strong administrative experience in the area of employee supervision and financial accountability.

RN, BSN, or Bachelors degree required. Master in Nursing or Public Health preferred. Greater than 3 years Clinical / UM / Discharge Planning / Home Care / Ambulatory experience. Licensure in the State of North Carolina. Excellent interpersonal communication and negotiation skills. Strong organizational and time management skills. Ability to work independently.