Location: Wilmington, Delaware
Nemours is seeking a Clinical Delegation Oversight Care Coordinator.
This Delegation Oversight Care Coordinator - RN role involves oversight of delegated activities to ensure compliance with NCQA accreditation standards, CMS, and state regulatory requirements. Ideal candidate will be an excellent communicator (written and verbal) who is detail oriented, organized, able to read and interpret regulations and able to meet tight deadlines while handling multiple audits.
The RN delegation oversight care coordinator will coordinate team-based care to provide health services and education to patients and families through effective partnerships with Nemours Clinically Integrated Network (CIN) practices, community resources and medical professionals. Supports care coordination by utilizing critical thinking skills and nursing expertise in order to optimize patient outcomes amongst designated populations within the practice. Works with patients and families to ensure both medical and psychosocial needs are met in order to promote health and well-being. Works with CIN practices to addresses gaps in care and promotes timely access to appropriate care, increasing the utilization of preventative care and healthy behaviors to improve the health of the population at risk.
- Assist with the identification of delegated patients in the practice with special health care needs; by running registry reports and use the registries to plan and monitor care. Monitors and audits patient registries/lists in accordance with NCQA Standards. Assists children with special health care needs and families in obtaining needed care to optimize quality of life and outcomes when possible. Coordinate with insurances to help families understand their benefits.
- Coordinates, conducts and documents required pre-delegation assessments and annual NCQA assessments as necessary to comply with applicable state, federal and accreditation requirements.
- Conducts necessary monitoring and auditing work to ensure vendors comply with state, federal, NCQA and other applicable requirements.
- Review reports from Delegated Entities.
- Develops corrective action plans when deficiencies are identified and document follow-up to completion.
- Present delegate's performance to respective committees, including the preparation of documents for committee oversight of delegated functions.
- Review implementation of new or changed regulatory requirements to help ensure adequacy of controls of oversight activities.
- Provide guidance of new or changed regulatory requirements and implementation of processes.
- Analyzes and interprets existing and proposed legislation and regulations and determines their effects on delegation oversight process.
- Conduct risk assessments to identify required audit areas and audit frequency.
- Assist in developing audit tools of oversight activities.
- Work collaboratively with Delegation Manager/Director to develop, establish and maintain departmental processes and procedures.
- Performs the essential job functions of the Care Coordinator job description.
Current unrestricted DE nursing license required
3+ years of related experience