Job: Care Management Coordinator

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Jobing Description

The Henry M. Jackson Foundation (HJF) is seeking a Care Management Coordinator (CMC) to support the Defense and Veterans Brain Injury Center (DVBIC) located in Camp Pendleton, California.

Responsibilities:

1. RESPONSIBLE FOR COORDINATING THE CARE OF TBI PATIENTS ACROSS THE CARE CONTINUUM (60%)
* Serves as the primary chairperson of the weekly TBI interdisciplinary patient care team, schedules, plans, convenes and actively participates in the meetings to ensure that the plan of care for patients is communicated and acted upon in a timely manner.
* Facilitates communication with members of the interdisciplinary patient care team to ensure all tests, orders and consults are carried out in a timely manner to satisfy the needs of the patient and are in compliance with medical treatment facility policy and procedures.
* Ensures the TBI team meeting minutes are completed and distributed to team members weekly.
* Monitors and coordinates the care of TBI patients who do not require the intensive services of a medical case manager.
* Collaborates with others to resolve issues related to patient care, communication, policies, and resources.
* Serves as a resource to military, veteran, and community-based service providers, agencies and organizations.
* Serves as a resource to patients and their families to provide education, guidance and resources both in the MTF and community settings as deemed appropriate.
* Participates in meetings and communications with all ONT sites, Wounded Warrior Battalion (WWBN), TriWest Managed Care personnel and case management regarding TBI patients to ensure a smooth transition to network care if needed.
* Facilitates special coordination/resolution of care issues between the military Commands, MTFs, Tri-West, Veterans Administration (VA) and community medical providers, agencies and organizations.
* Maintains patient care management records (with administrative support).
* Collaborates with TBI team to develop practice environments that support shared decision-making and evaluates desired and actual patient care outcomes.

2. PROVIDES INDIVIDUALIZED PATIENT AND FAMILY CENTERED EDUCATION
* Assesses the TBI-related educational needs of each patient and/or family member to provide patient specific and appropriate recommendations and support working with medical treatment facility staff, other DoD agencies and supportive staff assistance as deemed appropriate
* Reinforces and clarifies provider treatment instructions, provides patient education literature per TBI program protocol, answers patient/family questions before they leave the clinic and documents the encounter in the appropriate database and medical chart, works with medical treatment facility staff, and other DoD agencies as deemed appropriate
* Executes telephone follow-up calls to patients to assess the TBI-related educational needs of each patient and provides supplemental information, reinforcement and clarification with appropriate documentation of the encounter
* Follow-up with patients via telephone call if non-compliance is hindering flow through the TBI clinical pathway.
* Makes referrals to other formal TBI education related program(s) after conferring with and getting approval from the patients provider and TBI team

3. RESPONSIBLE FOR TRACKING AND MONITORING PATIENT CARE OUTCOMES
* Manager of the MTFs TBI patient registry
* Tracks all service members diagnosed with or suspected of sustaining a TBI within the MTF catchment area in order to coordinate care between the direct care system and providers and to schedule patient care conferences per the TBI-program protocol working with medical treatment facility staff, other DoD agencies and supportive staff assistance.
* Executes follow-up telephone calls
* Participates by attending appropriate meeting and working with specialty care providers to be familiar with the evaluation of TBI and initiatives that are congruent with the organizations strategic plans, regulatory agency requirements, and clinical standards.
* Identifies, collects, and analyzes data that serve as a basis for program design and outcome measurement.
* Participates in data collection for quality improvement initiatives

4. MAINTAINS CLOSE COMMUNICATIONS WITH THE ONT PROGRAM MANAGER/DIRECTOR REGARDING OFFICE OPERATIONS
* Alerts ONT Director & DVBIC Site Director, DVBIC direct supervisor and division officer of internal medicine regarding issues with Military Commands, MTF, VA, and community agencies.
* Identifies and reports potential risk management and quality of care issues to direct supervisor
* Participates in Quality Improvement activities as appropriate
* Collaborates with leadership and TBI team members on development and promotion of TBI standards of care, policies, and forms
* Participates in meetings, and training as directed

Skills / Requirements

Required Knowledge, Skills and Abilities: Knowledge of, and skills in applying professional clinical practice guidelines, group dynamics, leadership, conflict management, care management and regulatory procedures of the MTF, its personnel, and its functions sufficient to: Demonstrate a high level of clinical competence in TBI care; Ability to work in team environment with healthcare professionals/military personnel; Identifies and participates in problem solving and/or improving the quality of patient care projects/efforts; Demonstrates interpersonal communication skills at all levels of the health care system. Basic knowledge of case management concepts and processes; experience preferred. Well developed interpersonal communication and negotiation skills. Well developed writing and presentation skills. Well developed team facilitation and conflict management skills.

Work Environment: Work area is usually an adequately lighted, heated, and ventilated office or medical facility setting. The work environment involves everyday risks or discomforts that require normal safety precautions.

Minimum Education/Training Requirements: Bachelor of Science degree (Nursing preferred); Masters degree (Administrative/Nursing preferred). Specifically a graduate of an accredited college or university.

Minimum Experience: 3 years experience in one or more of the following areas (5 years combined experience preferred): Community Health, Ambulatory Care, Ambulatory care or community-based medical case management, Clinical management or Care Coordination, TBI patient care. Formal upper undergraduate level course in community/public health and/or community-based case management required; experience preferred. Proof of current, unencumbered state licensure (if applicable).

Please apply on-line at www.hjf.org/careers Click "Advanced Search" and enter job number 207175 in the Job Opening ID box.

The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF) is a congressionally authorized, not-for-profit corporation that provides unparalleled scientific and management services to military medical research and education programs worldwide. Our mission is to advance military medical research. AA/EEO

For a comprehensive list of our benefits, please visit: http://www.hjf.org/careers/benefits.html