Care Coordination Nurse Advocate

Company: The Carpenter Funds Administrative Office of North
Location: Oakland
Posted on: May 9, 2022

Job Description:

A fantastic career opportunity, for a Case Management Registered Nurse, is now available with the Carpenter Funds Administrative Office of Northern California, Inc. ("CFAO"), located in Oakland, CA. The Care Coordination Registered Nurse will be part of the Carpenters Health and Welfare Trust Fund for California ("Fund"). Working in collaboration with the Health Plan, Fund Administrator, and associated healthcare vendors, the role will focus on improving the quality, affordability, and accessibility of healthcare to plan participants and their dependents. The Care Coordination Registered Nurse will be responsible for collaborating with healthcare providers and physicians on problem solving, prioritizing and facilitating patient care objectives, the coordination and development of staff education, and continued development of thought leadership. You will be helping participants that are facing some of the greatest challenges in their lives. As part of their care team, you will be a valued partner, using your knowledge, skills and compassion to assist them to effective, appropriate care and ultimately, the best health outcomes possible.The Care Coordination Registered Nurse will report directly to the Board of Trustees (BOT), but on a day-to-day operational basis will report to the BOT designated representative. This is a salaried, exempt, full-time, in-person position located onsite at the Oakland, CA office, with some required travel. This position qualifies for Health, Pension, Annuity, 401(k), and Vacation, Holiday/Sick Leave benefits. The ideal candidate is expected to be proactive, take the initiative and be the leader of the Fund's efforts to improve the quality, affordability, and accessibility of healthcare to participants.The Carpenters Health and Welfare Trust Fund for California covers approximately 72,000 lives, of which 24,000 actives and retirees are enrolled in the indemnity plan and provides medical, behavioral health, substance abuse, prescription drug, dental, vision, EAP, and hearing benefits to eligible participants and dependents. The balance are enrolled in Kaiser. The Health Plan also provides financial protection through short-term disability benefits and life and accident insurance coverage. In addition to the Health and Welfare Fund, the Carpenter Funds Administrative Office of Northern California, Inc. (CFAO) administers Pension, Annuity, 401(k) and Vacation, Holiday/Sick Leave benefits for over 50,000 members/retirees. The Health and Welfare Fund has assets of over $800 million while Pension and Annuity has assets exceeding $8.5 billion. The CFAO is a team of 100 benefit professionals dedicated to providing best in class customer service in a caring and collaborative working environment and, as such, has very low employee turn-over. Please visit https://carpenterfunds.com/ for more information about the Northern California Carpenter Funds.RESPONSIBILITIESSpecific responsibilities include, but are not limited to, the following:Obtain necessary clinical and treatment plan information from Anthem, ESI and providers to facilitate necessary patient care. Act as a liaison between patient, family, nurses, doctors, vendors, and others to facilitate proper and efficient delivery of services to patients.Focus on oncology and complex cases by evaluating the need for alternative services and, as appropriate, assess, plan, implement, coordinate, monitor, and evaluate options and services to meet an individual's healthcare needs.Develop and maintain good working relationships with hospitals, and other health care entities, to facilitate quality patient health care management.Educate providers and participants on the in-network clinical resources that are available to them within the Fund's health plan design.When appropriate, coordinate with the Fund's vendors for care coordination with providers; facilitate patient and family education, discharge planning and follow-up care.Act as a plan expert for available network resources.Understand and assist in participant referrals to community resources, including, but not limited to, free services, not-for-profit services, and state/county services for patients with chronic diseases.Educate participants/families on availability of quality providers, including Long Term Acute Care, rehab, and skilled nursing facilities.Identify and refer potential candidates for Disease Management, Case Management or other programs that would be beneficial to the overall health of the participant.Oversee utilization and monitor length of stay to assure utilization trends are appropriate in concert with Anthem.Investigate, document and report quality issues to appropriate parties.Develop short-term and long-term healthcare strategies that focus on prevention and early detection of diseases, including wellness programs, classes, and clinics.Through a holistic approach, promote quality case effective outcomes, and provide quality, cost effective alternatives to acute care.When possible and appropriate, negotiate fees for services, level of care, intensity, and duration with provider(s).Assist in and monitor specific clinical programs, e.g., Disease Management and Advanced Opioid Management Program, Case Management Programs.Review and recommend enhancements to specific programs and processes, especially in the area of high-cost claim management and oncology.Review of PBM utilization, where applicable, noting trends of utilization to include formulation of educational interventions for individuals and total group of participants, at large.Review and assist Trustees in adjudicating appeals.Attend Benefit Committee meetings to present a clinical perspective, review of clinical utilization reports, discuss healthcare services as related to the plan and address concerns from a clinical perspective.Organize educational events to feature subject experts to improve health of participants.Collaborate with the Fund's vendors to increase quality of services available to participants.Potentially develop, coordinate, and attend events and patient education programs.When appropriate, attend participant meetings, including Union meetings.On a monthly basis, review large dollar cases, as identified by Anthem and ESI, with subsequent and routine direct interaction with these participants.Develop, implement, and monitor plans of care for at-risk or non-compliant participants from the advocacy standpoint. Measuring markers of achievement and missed opportunities of the interactions.Record and maintain documentation of individual patient interactions to include advocacy interventions performed and outcomes, when possible. These individual interactions must be formulated into an aggregate summary report to demonstrate effectiveness of the advocacy program, which will be maintained by the RN.Perform other duties, as assigned.REQUIREMENTSThe ideal candidate will meet the following requirements:Work Experience: A minimum of 3 years of experience as a Registered Nurse (RN) with direct patient care experience is required. A minimum of 2 years in case management within an acute care hospital setting, physician office, or within a medical management organization is preferred. Experience in a high acuity level i.e., ICU, CC, ER, and/or mental health and substance use, Tele - Health, Telephonic Triage is also preferred. Prior experience with health plans, self-funded plans, and/or in Taft-Hartley or collective bargaining environment is a plus.Educational Background: Currently must have an active and unrestricted RN license. Minimum of an Associate's degree from a two-year technical college or technical school, or diploma nursing program; Bachelor's degree is preferred. Certificate as a case manager is preferred.Special Skills or Credentials: Valid Driver's License and insurance, primary form of transportation is required. Excellent time management, organizational, research, analytical, negotiation, communication (verbal and written) and interpersonal skills are necessary, and computer skills and typing expertise are all required. Ability to assess complex issues, recommend changes and resolve problems in a timely manner with a sense of urgency. Ability to manage multiple tasks and effectively prioritize various requests and responsibilities. The ideal candidate will be able to work independently, receiving direction from a manager for new, or unprecedented, situations and have the capability to manage one's own caseload and coordinate all assigned cases. Proactive and positive attitude, always willing to collaborate with team members and colleagues. Ability to thrive in a fast-paced, dynamic, working environment. Bilingual (Spanish/English) is a plus but not required. This position requires the Care Coordination Nurse Advocate to be onsite and, in the office, located in Oakland, CA, on a full-time basis (this is not a remote position).COVID 19 Vaccination Policy: The CFAO has a mandatory COVID 19 vaccination policy that requires proof of vaccination prior to starting employment. Accommodation requests will be considered as required by law.TO APPLYThe CFAO offers a competitive salary and a comprehensive benefits package which includes employer paid family health plan, Pension, Annuity, optional 401k, paid vacation and holidays, short and long term disability, and life insurance. The CFAO is an affirmative action employer and encourages applications from all qualified candidates regardless of gender, race, ethnicity, age, sexual orientation, marital status, religion, or disability.To apply, please send your resume and salary requirements to atcresumes@segalco.com. Please include job reference code 0522NURSECAMN in the subject line or with your application.

Keywords: The Carpenter Funds Administrative Office of North, Oakland , Care Coordination Nurse Advocate, Healthcare , Oakland, California