Local Care Coordinator, RN (Patient-Centered Medical Home)

CareFirst BlueCross BlueShield
Washington, DC; Silver Spring, MD; Wheaton, MD; Rockville, MD; or Potomac, MD
Jun 07, 2017
Jul 12, 2017
Full Time

CareCo, a subsidiary of CareFirst, Inc., is seeking experienced RNs who are looking to be part of a program that is changing the face of healthcare in the Baltimore/Washington Metropolitan areas. Much different from other such programs, CareFirst launched its Patient-Centered Medical Home (PCMH) Program in 2011 and currently has more than 4,000 participating primary care providers organized into over 400 Panels. The PCMH Program, now in its 7th year of operation is the center of CareFirst's approach decreasing the cost and increasing the quality of health care provided to our members. Care coordination for members with multiple chronic illnesses is carried out through a Registered Nurse (RN) known as a Local Care Coordinator (LCC).

The “Local Care Coordinator (LCC),” with the support and guidance of the CareFirst Regional Care Director (RCD), supports the implementation of the CareFirst Patient-Centered Medical Home (PCMH) program by working with patients (members) qualified for Care Plans, primary care providers (PCPs) and regional support teams. The Local Care Coordinator will advocate, guide and intervene on behalf of their patients (members) to ensure successful implementation of the Care Plan. This role acts as the primary interface between the CareFirst program and individual primary care providers (PCPs) and their patients (members).

Opportunities exist for qualified candidates in the following geographic regions:

District of Columbia; Southern Maryland; Silver Spring; Wheaton; Rockville; Potomac, MD.

Under the general supervision of a Regional Care Director, RN the incumbent's accountabilities may include, but are not limited to, the following:

  • In partnership with the Regional Care Director (RN), develop and maintain strong working relationships with PCPs to integrate the PCMH program into their practices, contributing value to the PCP and CareFirst members. Serves as an extension of the PCP office.
  • Provide on-site consultation to PCP offices and Care Coordination Team providers related to implementation of the PCMH model including development and documentation of Care Plans for individual members, tracking processes, member self-management support, implementation of clinical practice guidelines and work process/patient flow improvements. Follow-up with parties as appropriate.
  • Collaborate with PCPs in the development, documentation and implementation of Care Plans and delivery of coordinated services for members identified through this CareFirst program.
  • Maintain the electronic Care Plan.
  • Utilize established documentation standards to maintain quality of Care Plan documentation to include member progress toward and barriers to achievement of Care Plan objectives/outcomes.
  • Develop communication and referral mechanisms to assure that there is seamless communication between PCMH, PCP and the Care Coordination Team.
  • Abides by PCMH Program Description and Guidelines.
  • In conjunction with Regional Care Director (RN), develop clinical reports for use in PCP office, facilitating PCP support of members in behavior change.
  • Assist the member in coordination of any additional tests, images and consults with specialists as deemed appropriate by the PCP. For selected members with multiple prescriptions, perform a comprehensive medication reconciliation (CMR) at the onset of the Care Plan, as well as every thirty days during the life of the Care Plan, or when any medication is changed, added or deleted, assessing for efficacy and drug interaction/side effects.
  • Assist the member in mitigating issues and removing barriers to care.
  • Direct the PCP to the Program Consultant or RCD when he/she identifies an opportunity for education or additional learning needs surrounding the member that are outside of their understanding.
  • Conduct patient education in support of standards of care guidelines and related health issues using the most appropriate modality for the member.
  • Facilitate the completion of member satisfaction surveys.
  • Verbally or physically connect with each member every week.


Local Care Coordinators are the face of CareFirst in provider offices, interacting directly with CareFirst members face to face and telephonically. Like other RN's providing care coordination, LCCs must be fully versed in all aspects of PCMH and TCCI in order incorporate the TCCI elements into effective and successful Care Coordination.

Required Education/Experience/Skills/Abilities:

  • Healthcare background and current licensure as Registered Nurse (RN) is required.
  • Minimum 3-5 years clinical experience in any of these areas: acute care, home health, physician office management, managed care organization, provider relations, pharmaceutical sales.
  • Demonstrates ability to be self-directed, highly organized, multi-tasked capable, and proficient in problem solving skills
  • Demonstrates exceptional oral, written, and presentation skills.
  • Demonstrates success in influencing patients and providers. Outstanding customer service skills and ability to adapt approach to various personalities
  • Demonstrates ability to work effectively with all levels of administrative and professional personnel.
  • Demonstrates proficiency with data analysis and ability to organize data in support of reporting needs.
  • Demonstrates computer competencies to include word processing, spreadsheet, presentation preparation, and data base management. Demonstrated ability to learn customized computer applications.
  • Demonstrates ability to proactively identify and assimilate quality improvement processes into practice.
  • Ability to extrapolate information from a variety of sources including medical records to create concise records that accurately depict the medical “story” of the member
  • Maximize all technology inclusive of iCentric, Skype, Microsoft Word, Microsoft Excel, Microsoft Outlook, laptop computers, iPhone, and all other relevant CareFirst unified communication technologies.
  • Experience with medically oriented care plan documentation
  • Comfort with managing multiple tasks and continually re-prioritizing
  • Experience working effectively within a matrix organizational design.
  • Has valid driver's license and driving record showing no restrictions that would impede ability to travel by automobile.
  • Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
  • Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Travel requirement: 50 - 80% (variable) within assigned region.

BSN Nursing preferred.

Keywords: Registered Nurse, RN, Nurse, Nursing, Medical, Healthcare, Health Insurance, Care Coordination, Case Manager, Care Program, Home Health.

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Please visit our website to apply: www.carefirst.com/careers

Must be eligible to work in the U.S. without Sponsorship

Please see job description.


Apply Here: http://www.Click2Apply.net/twjn7v75tsf9wjp8



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