Clinical Claims Care Coordinator RN

The nation's leading administrator of long term care insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative. WE ARE THE KIND OF EMPLOYER YOU DESERVE. illumifin is a leading provider of business process outsourcing for the insurance industry, managing over 1.3 million long-term care policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary long term care databases. This position manages the assessment process and coordinates follow-up on referred clients. The Clinical Claims Care Coordinator is the main contact person for the client and develops and manages the plan of care, assists clients with finding services and follows the client telephonically at regular intervals as directed. The position is work from home, but requires 2 weeks of training in our Waltham, MA office. RESPONSIBILITIES 1. Reviews onsite assessments for consistency and quality and develops plan of care in collaboration with the field nurse. 2. Identifies and assesses clients' health care needs across a continuum of care. 3. Prepares a professional, objective report for the insurance customer summarizing information from the assessment using company formats. The report is based on the basic principles of case management and the Five Steps of the nursing process: assessment, diagnosis, planning, implementation and evaluation. Understands how the medical conditions, functional and cognitive deficits affect an individual's safety and how to incorporate this information into an individualized, comprehensive plan of care. 4. Makes the initial contact with the client/family/contact to set the expectations for the assessment process and evaluate need for immediate provider services. 5. Coordinates and implements home care services and community resources for clients across a continuum of care. 6. Provides ongoing regular evaluation of appropriateness of services as they relate to changing health conditions of clients. Updates the individualized plan of care on an ongoing basis to reflect changing client care needs. 7. Obtains information from physicians, family members, third-party payers, caregivers, or other health care providers (such as social worker, adult daycare worker, Medicare nurse) as needed to prepare a comprehensive plan of care and ongoing updates related to care coordination. 8. Other duties as assigned. Minimum Qualifications * Associate degree or diploma in Nursing or Bachelor's Degree in Social Work * Registered Nurse: 2 years of geriatric experience required * Current, valid and unrestricted Registered Nurse license. * Must type at least 40 words per minute. Preferred Qualifications * Bachelor or Master's Degree in Nursing or Master's Degree in Social Work. * Prior experience in home health care, geriatrics, assessments, knowledge of community resources, experience in various clinical areas, case management, insurance, and mental health * Advanced practice or specialty certification in the areas of gerontology, case management, rehabilitation, community health, insurance, home health, and hospice and palliative care.