• Lead a team of Care Extenders in Mindoula's Interpersonal Violence Reduction Program • Act as a player/coach, working alongside Care Extenders to build their skills • Create and coordinate service plans and community resource guides • Monitor and evaluate members’ progress according to measurable goals • Build accountability communications about appointments • Interact with members, families, and providers utilizing clinical expertise • Report critical incidents and quality-of-care issues • Lead the Care Extender team to ensure member needs are assessed and addressed • Participate in hiring, orientation, training, and performance reviews of new team members

Overview Facilitates and coordinates all direct admissions, interhospital transfers as well as transfers in accordance with established processes and regulatory (TJC, CMS, EMTALA guidelines). Actively collaborates with providers, nursing, and case management/utilization management to ensure appropriate patient placement for optimal care provision. Assures that all bedded patients (Excluding Behavioral Health and Obstetrical patients) are placed in the appropriate room accommodations and patient status when admitted. Qualifications Certifications: Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR), Education: College Diploma: Nursing; Work Experience: 3+ years of Nursing Responsibilities Assesses and coordinates clinically appropriate bedding of all patients (Excluding Behavioral Health) - Facilitates bed assignments for scheduled patients, direct admissions, patients being admitted from ER, surgery and all ancillary departments including outpatient observation/outpatients. - Collaborate with physicians, nursing, and other hospital staff to assure that resources/beds are available, and the patients are placed in the appropriate room accommodation for care needs - Meets established metric’s achieve throughput and monitors progress related to placement and scheduling. - Responsible for identifying and escalating bedding issues promptly and appropriately to leadership when established time metrics are exceeded. - Meets established metrics to ensure all rooms are cleaned in a timely manner and notifies EVS by changing the bed status on all Stat and Next cleans. - Meets with director to review metrics monthly. - Collects data for process improvement purposes as requested by leadership Coordinates and facilitates direct admissions, interhospital transfers in accordance with hospital processes and EMTALA guidelines as applicable. - Obtains information intake from physician offices and facilitates clinical handover as requested on all direct admissions - Obtains information intake and facilitates recorded telephone communication between sending and receiving physicians and other facility staff on all transfers from outside facilities. - Maintains current knowledge of and monitors facility compliance with EMTALA guidelines on each applicable transfer, completes documentation per hospital guidelines. - Performs admission Utilization review on all direct admissions & transfers to support appropriateness of admission. Communicates findings to receiving/admitting physician for use in decision-making as needed. - Responsible for identifying and escalating direct admission or transfer issues promptly and appropriately to leadership - Partners with nursing, case management and/or social workers to facilitate smooth out bound transfers to other hospitals, this includes the Emergency Department transfers. Phase 2 will be outbound discharges to long term care facilities. - Identifies data for process improvement purposes. - Facilitates recorded three-way calls between referring provider and receiving provider. Provides an assigned bed upon request of transfer prior to provider-to-provider call. - Facilitates and records the nurse-to-nurse report from sending to receiving hospital unit. - Clinical admission specialist ensures that requested bed placement is appropriate as identified by the provider-to-provider discussion, and that patient needs can be met. - Assumes principal responsibility for the coordination of acceptance, admission and transfer, and necessary communication between the referring physician, attending physician and clinical staff - Ensures the admission requirement form is completed and in the record within 24 hours of admission. - Works with the sending facility to arrange mode of transportation needed: ground, air stat or routine. About Us Find it here. Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance – and opportunities meet flexibility. Find it all at Carle Health. Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Health Alliance™. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com. Compensation and Benefits The compensation range for this position is $30.39per hour - $52.27per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.

Company : Highmark Inc.Job Description : JOB SUMMARY This job manages and coordinates the supervisory staff that has accountability for the case management, medical review, utilization review, quality management and/or health education team and programs. Monitors and evaluates the operational performance of overall departmental direction, leveraging analytics, regional market trends and utilization trends of members to set future direction and refine current state. Develops longer term plans that will improve utilization, quality and clinical outcomes based on market trends, legislative environment and company’s mission, vision and direction. The incumbent is responsible for the leadership, performance management for supervisory staff as well as company and department objectives, supporting providers in a variety of health care settings to appropriately identify members with chronic conditions and/or gaps in care that can be positively impacted related to quality and care costs. (note that health care settings could include, but not limited to, working in a physician’s office, visiting physician practices on a routine basis, working within a hospital setting and/or assessing and coordinating member’s care within the member’s home). ESSENTIAL RESPONSIBILITIES Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority. Assist in the development of goal-setting and establishing future direction of the operations of a combined case management/utilization management team and assist with operations planning and efficiency. Ensure overall compliance with applicable business process requirements, regulatory requirements and accreditation standards that support all lines of business. Serve as key resource to both supervisory staff and external sources on complex issues, departmental direction and future planning. Develop proposals to improve overall efficiency and managed care experience, utilization, quality and clinical outcomes. Collaborate with supervisor staff and providers for insights to inform future direction and refinement of overall operations. Collaborate with the appropriate cross- functional leadership and external entities to formulate new, innovative ideas to improve departmental performance and reduce costs while enhancing member experience. Other duties as assigned or requested. EDUCATION Required RN OR Bachelor’s or Master’s degree in Social Work Substitutions None Preferred Bachelor's Degree in Nursing EXPERIENCE Required 5 years of experience in Clinical, Utilization, Case and/or Disease/Condition Management, Provider Operations, Health Insurance, and/or other relevant experience 3 years in a management or leadership role Preferred None LICENSES or CERTIFICATIONS Required Clearances as required by specific practice or hospital, as applicable Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) (OR) Current Social Work license (e.g., LSW, LCSW, LMSW, LBSW). Additional states may be required depending on member area served. Preferred Certification in Case Management (CCM) Skills Proficiency in MS Excel and enhanced data and statistical analysis skills Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization Broad knowledge of the health care delivery system including an understanding of health care costs drivers Excellent verbal and written communication skills including individual and/or group education/training Experience working with the healthcare needs of diverse populations and understanding the importance of cultural competency in addressing targeted populations. Self-directed; self-starter; ability to work successfully with indirect supervision and moderate autonomy Excellent organizational, time management and project management skills Ability to work in a fast paced, high visibility, high performing team environment that requires flexibility Ability to travel locally and work flexible hours in a practice or facility-based settings Ability to communicate effectively in more than one language, preferred Experience working directly with physicians in provider practice settings, members in a home environment or hospital discharge processes. Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Never Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.Pay Range Minimum: $94,200.00 Pay Range Maximum: $151,000.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Join us at NextStep Care– a place where you’ll be valued, recognized and rewarded for the vital work you do each day. We’ll surround you with a strong team and leadership that supports every aspect of your life – both inside and outside of our centers. And you’ll get to practice your passion in a non-profit, mission-driven organization that’s known for the highest level of care in our communities SUMMARY Responsible for serving as the Care Management Services’ member liaison and representative by ensuring the goals of the program and those of individual members are met through primary care enhanced case management. A primary function of this position is to complete member assessments. ESSENTIAL DUTIES AND RESPONSIBILITIES - Observes members in their home environment gathering medical, environmental, and psychosocial data for review by the multidisciplinary team. - Accepts referrals and ensures potential members are screened in a timely manner as required by organization and governmental policies. - Addresses member or caregiver concerns effectively and efficiently. - Assist in carepath developments, recommending HCBS services and incorporating roles for informal caregivers. - Records and documents member information completely and accurately in accordance with federal, state, and operational guidelines. - Works to preserve the essential role of the family and informal caregivers in assisting embers in meeting carepath goals and addressing social risk by following up on needs identified in data gathered from members/caregivers. - Makes recommendations to multidisciplinary team that address primary care needs - In conjunction with the Care Manager for Care Management Services and the multidisciplinary team, assists in removing barriers to primary and specialized medical care, to support optimal health and functional status. - Collborates with effectively with the Quality Department in resolving items needing additional information or clarification when identified on assessment review, to ensure standards of promptness and members needs are met in a timely manner. - Advocate for informed decisions by members and caregivers regarding their health stauts and options for treatment or care. - Promotes quality outcomes through effective collaboration with the Quality Assurance and education Coordinator, Assessment Coordinator, and Administrator to ensure effective implementation of education plans, initiative, or processes. - Utilizes technology to promote workflow efficiency and to facilitate data collection, management and analysis. - Takes call on a rotating basis as assigned. - Provides on-site assistance for all state surveys. - Reports corporate compliance concerns appropriately. - Reports privacy and security concerns appropriately. - Reports work time and business expenses in accordance with organizational guidelines. - Maintains prompt, accurate and secure documentation as it relates to member needs, contacts and plans. - Maintains prompt, accurate, secure documentation as it relates to member needs, contacts and plans. - Ensures appropriate documentation is filed promptly in members’ chart as outlined in Care Management. - Assists with Assessment Nurse Case Manager duties for other Care Management Services’ locations as needed - Promotes the image and reputation of the System by exhibiting servant leadership and providing direct and open lines of communication. - Contributes to the work of committees, workgroups, project management, and other collaborative efforts of the System. - Performs other duties as necessary to ensure the success of the System. SKILLS AND ABILITIES - Completes work in a timely, accurate, and efficient manner. - Ability to organize and prioritize assignments/responsibilities. - Maintains constructive working relationships by communicating and interacting effectively with supervisors, organizational leadership, peers and individuals inside and outside the Organization, in a positive, professional and respectful manner - Portrays a positive image of the organization and communicates guiding principles, mission, vision and values. - Completes work in a timely, accurate, efficient and thorough manner and is conscientious about assignments/responsibilities. - Consistently reports to work on time prepared to perform duties of the position. - Manages multiple deadlines with demonstrated flexibility in working with changing priorities. - Ability to work a demanding, primarily self directed work schedule. - Demonstrates good judgment and decision making. - Exhibits exceptional organizing and planning skills. - Ability to deliver excellent customer service, externally and internally as well as maintain customer confidentiality. - Ability to react effectively and calmly in emergency situations. MINIMUM QUALIFICATIONS ·Valid Georgia LPN license with 2 years of experience in the health and human services field ·Experience in social work, home and community based services, healthcare or geriatrics preferred. ·Valid Driver’s License. ·Reliable transportation. SUPERVISORY RESPONSIBILITIES None LANGUAGE SKILLS Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or associates of the organization. MATHEMATICAL SKILLS Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. REASONING ABILITY Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram format. The ability to deal with problems involving several concrete variables in standardized situations. COMPUTER APPLICATION SKILLS This job requires proficiency with the following computer applications: Microsoft Outlook Microsoft Excel Microsoft Word CERTIFICATES, LICENSES, REGISTRATIONS Please see minimum qualifications PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the associate is regularly required to sit, talk or hear. The associate frequently is required to walk. Use hands to finger, handle or feel and reach with hands and arms. The associate is occasionally required to stand. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus. EEO / M / F / D / V / Drug Free Workplace NextStep Care Facebook