Position Description:

Responsibilities:
• Responsible for carrying out telephonic Disease Management, training and other clinically based activities as assigned to coordinate care between providers, the Medicaid member and the community.
• Communicating with providers in the community regarding the consumer's treatment needs and developing appropriate care plans for specialized needs of members.
• Responsible for medical record reviews and giving feedback to Primary Care Physicians regarding their obligations under the DCH program.
• As appropriate, provide group education to members in community location. Education is specific to disease processes, nutrition, wellness, etc.
• Will make adequate contact, to members, as stated in Program guidelines with a focus on behavioral goal setting and member centered support planning.
• Will verbalize/demonstrate understanding of diabetes, asthma, COPD, CAD, and CHF disease processes and self care management.
In addition, responsibilities will include providing education by interacting with members/family, practitioners, social workers and medical office staff to obtain established goals and outcomes for members
• Performing Care Plan development and follow-up in accordance with established goals
• Monitoring for quality of care and outcome improvement in accordance with clinical indicators as per contractual obligations
• Communicating with providers in the community regarding the consumer's treatment needs and developing appropriate care plans for specialized needs of members;
and
• Will identify member resource needs and provide information on possible resources to members and make referrals as needed
• Others duties as assigned

Educational Requirements:
• Registered Nurse with active Georgia license
• Qualifications:
• Minimum of 2-3 years experience in related public sector medical services including experience with quality improvement, medical record reviews, disease management and/or
• Two years of current clinical nursing experience and must possess clinical experience in an area such as medical, surgical, critical care, home health or skilled nursing.
• Experience with chronic illness and disease states targeted by DCH strongly preferred;
• Strong verbal and written communication skills
• Experience with clinical care computer systems, data entry and call center environment preferred;
• Customer service focus; and
• Ability to utilize critical thinking and problem solve in a non-threatening manner