RN Care Coordinator, Complex Care Management

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Company: Oak Street Health
Title: Care Coordinator, Field Operations
Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an unmatched experience for adults on Medicare in medically underserved communities. By providing holistic, comprehensive and integrated care right in our patientsâ communities, we can help keep them healthy and reinvest cost savings in further care for those same communities and others. Since 2013, Oak Street Health has brought its singular approach to tens of thousands of people across the nation. With an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oak Street values and are passionate about our mission to rebuild healthcare as it should be.
For more information, visit www.oakstreethealth.com.
Role Description:
This position coordinates care for Oak Street Health members. This position works collaboratively with interdisciplinary care teams that may include the memberâs PCP, specialists, Social Worker, Behavioral Health Specialist, and community resource contacts, while functioning with professional autonomy under the supervision of the Complex Care Management leadership team. This position performs appropriate assessments, organizes, reviews, and reports health and social information. Individuals in this position demonstrate cultural sensitivity, effective communication, and motivational interviewing skills.
Core Responsibilities:

  • Manage an assigned caseload of members while remaining in compliance with all internal and regulatory requirements
  • Create and nurture relationships with all assigned members working towards their optimal overall health and well-being
  • Be the system navigator and point of contact, in collaboration with administrative support, for members and families
  • Conduct complete, timely, and accurate program specific assessments
  • Develop and maintain a person-centered care plan or family driven care plan for all members in assigned caseload involving the memberâs PCP, family/caregiver, Social Worker, Behavioral Health Specialists, and other specialists, as needed to evaluate the individualâs needs, goals, and plan of action
  • Complete all activities and interventions outlined in the members care plan and ongoing monitoring of cases to ensure routine follow up and progression in their care plan goals
  • Document visits in electronic health record according to standards set forth in delegation contracts
  • Specific delegated services may require Care Coordinator to schedule and maintain interdisciplinary care team (ICT) meetings and to facilitate associated activities with members and their identified support team while maintaining strong communication with the memberâs care team
  • Maintain HIPAA standards and confidentiality of protected health information
  • Other duties, as assigned

What are we looking for?

  • Current RN License in good standing in the state of practice OR LCSW license in the state of practice required
  • Minimum of three (3) years clinical experience, HMO /Managed Care setting preferred
  • Care Coordination / Case Management training
  • Knowledge of community resources in assigned service area
  • Knowledge of clinical standards of care preferred
  • Knowledge of Medicaid/Medicare contracts and benefit systems is preferred
  • Demonstrated customer-focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary care team, community agencies, members, and families
  • Ability to work autonomously, follow through with delegated tasks and be directly accountable for deliverables
  • Outstanding verbal and written communication skills
  • Ability to work independently and maintain flexibility in a fast-paced, start-up environment
  • A high-level of accountability and responsibility for the outcome of care
  • Strong presentation and facilitation skills
  • Ability to affect change, work as a productive and effective team member, and adapt to changing needs and priorities
  • Excellent organizational skills and ability to manage multiple priorities appropriately
  • Independent problem-solving skills
  • A flexible, positive attitude
  • Experience working with Inner City, Suburban, and Rural neighborhood members
  • Access to reliable transportation - able to travel daily
  • Working knowledge of Microsoft Office Product Suite
  • Working knowledge of Google Suite
  • Familiar with variety of Electronic Medical Records platforms preferred
  • US work authorization
  • Someone who embodies being â Oakyâ

What does being â Oakyâ look like?

  • Radiating positive energy
  • Assuming good intentions
  • Creating an unmatched patient experience
  • Driving clinical excellence
  • Taking ownership and delivering results
  • Being scrappy

Why Oak Street?
Oak Street Health offers our coworkers the opportunity to be at the forefront of a revolution in healthcare, as well as:

  • Collaborative and energetic culture
  • Fast-paced and innovative environment
  • Competitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply to oakstreethealth.com/careers.

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30 W. Monroe St, Chicago, IL 60603

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