MSHO/MSC+ Care Coordinator

HealthPartners; BLOOMINGTON, Northern (MN, KY); Hybrid; USD 60,000 - 85,000; Full time

Job summary

HealthPartners in Bloomington, MN is seeking an MSHO/MSC+ Care Coordinator to support patients, families, and physicians by addressing medical and social needs, educating patients to make informed decisions, and enhancing communication among members, providers, and plans.

The role emphasizes case management, care coordination across services, and confidentiality, with MN licensure required and a focus on quality improvement and teamwork within a progressive health system.

Qualifications

• Qualified social worker or registered nurse with MN license in good standing.
• Minimum 2 years' home and community-based experience.
• Knowledge of MSHO/MSC+ plans and utilization management.
• Strong written and verbal communication, independent judgment.
• Familiarity with quality improvement processes.
• MnCHOICES Assessor Certification or ability to obtain within 3 months.

Responsibilities

• Provide member-focused care coordination to address medical and social concerns.
• Educate patients and families to empower informed health decisions.
• Coordinate communication among patient, physician, health plan and community resources.
• Maintain documentation in accordance with policy and procedures.
• Identify and report high-cost cases and potential risks to leadership.
• Collaborate with multidisciplinary team including case management and government programs.

Skills

Communication skills

Case management

Utilization review

Medicare/Medicaid knowledge

Professional judgment

Electronic health records

Education

RN license in MN

BSN preferred

Tools

Electronic Health Records

Job description

HealthPartners is hiring an MSHO/MSC+ Care Coordinator. This position exists to provide support to patients, their families, and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.

ACCOUNTABILITIES:

• Member Focus
  • Ensures all activities are member-focused and individualized, resulting in personalized attention to each patient’s unique needs.
  • Identifies interventions and resources to assist member reaching personal health related goals.
  • Identifies patterns and episodes of care that are predictive of future needs and services.
• Integration
  • Integrates clinical and psychosocial information for case identification and individual patient assessment to develop action-oriented and time-specific planning and implementation of appropriate interventions.
  • Facilitates integration of patient care by encouragement of effective communications between patients, families, providers, health plan and care system programs, and community-based services.
  • Adheres to department policy and procedure in daily activities.
  • Coordinates service coverage with appropriate funding sources when indicated.
  • Works with Supervisor, Case Management, Government Programs department and Member Services department to ensure compliance with Medicare requirements and regulations.
• Communication
  • Effectively communicates with patients and their families to provide them with a better understanding of their health, health care benefits, and health care system.
  • Effectively and routinely communicates with patients, families, physicians and health care team members to facilitate successful collaboration resulting in high levels of member/patient/family/provider satisfaction.
  • Provides educational information and materials to members to support preference sensitive decisions.
  • Provides regular reporting of member outcomes to Case Management leadership according to defined process.
  • Identifies and promptly reports potentially adverse situations to leadership as outlined in department policy and procedure.
  • Identifies and promptly reports high cost cases for reinsurance.
  • Maintains current and accurate documentation and case management files in accordance with Case Management policy and procedure.
  • Maintains confidentiality of information in accordance with department and corporate policies.
• Relationships and Team Building
  • Establishes and maintains good working relationships within the Comprehensive Care Advocacy department, with other HealthPartners departments, and with other health team participants.
  • Supports other team members in achieving patient centered goals.
  • Assists supervisor in maintaining a cohesive Case Management team by contributing to a collaborative, respectful, and diverse environment.
  • Participates in and contributes to appropriate departmental and/or organizational meetings.
• Technology
  • Maintains knowledge of and effectively uses automated applications and systems.
  • Identifies deficits in technological literacy and seeks appropriate training under guidance of supervisor.
  • Maintains maximum individual productivity through proficient use of automated systems.
• Personal Development
  • Participates in ongoing independent study and education-related professional activities to maintain and increase knowledge in the areas of Case Management, patient care services, and benefit packages for development of effective case management skills.
  • Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development.
  • Maintains current, active Minnesota nursing or social work licensure.
  • May maintain current, active nursing or social work licensure in other states as assigned.
• Other Duties
  • Willingly participates in various committees, task forces, projects, and quality improvement teams, as needed and assigned.
  • Performs other duties as assigned.

CURRENT DIMENSION:

• Directly reports to Supervisor, Case Management.
• Directly manages caseload with anticipation of up to 85 members with complex needs.
• Interacts with medical, administrative, and front line staff within and outside the organization in order to collaborate on members care.
  

REQUIRED QUALIFICATIONS:

• Social Worker or Registered Nurse considered RN with BSN preferred, must have current unrestricted license in the State of Minnesota. License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure
• Minimum of 2 years of home and community based experience; experience with relevant utilization review, discharge planning, or case management experience; and current clinical knowledge
• Demonstrated effective, independent professional judgment and skills
• Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication
• Demonstrated working knowledge of quality improvement, utilization management, MSHO/MSC+ plans, fiscal management. Understanding of healthcare and/or MCO industry
• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations
• MnCHOICES Assessor Certification in place or within 3 months of hire date
• Demonstrated flexibility, organization, and appropriate decision-making under challenging situations.
• Basic computer skills

CHALLENGES:

• Maintaining member focus in a rapidly evolving environment.
• Influencing team members and colleagues to work collaboratively in achieving the goals and objectives of the Case Management Program.
• Contributing a positive team building approach as a member of the Case Management team, and a global member of the Case Management Department.

DECISION-MAKING:

• Makes independent decisions within the scope of this position’s accountabilities and determines the need for and the timing of consultation with Case Management leadership and/or Medical Director.
• Uses professional clinical judgment, organizational knowledge, industry knowledge, and common sense in determining appropriate alternatives for members/patients/families, consulting with leadership and/or Medical Director, when indicated.
• Makes recommendations to leadership regarding policy development needs and/or changes.