Member Certification Manager jobs in Vallejo, CA

Ability to work effectively under pressure in a fast-paced environment by prioritizing work activities, handling multiple tasks, working with interruptions, negotiating deadlines, and dealing with confidential information

Demonstrates dependability and organizational abilities

Knowledge of Microsoft Office; electronic health record system preferred

Knowledge of Federally Qualified Health Centers 

Provide Medical Nutrition Therapy (MNT) and nutritional screening for CommuniCare OLE patients utilizing the Nutrition Care Process (NCP) at any time during the patient’s health care continuum, including pediatrics, perinatal nutrition, adult nutrition, chronic disease management, and geriatrics: Conduct assessment of patient’s nutritional risk status utilizing patient medical diagnosis and Provider orders, patient medical history/lab data, social determinants, and other clinical information relating to patient care; Determine nutritional diagnosis and develop individualized intervention and care plan and provide long-term monitoring and evaluation of patient nutritional status and health goals

Schedule and conduct follow-up MNT visits based on acuity of illness, medical diagnosis, and patient need per assessment and care team input

Confer with, serve as a resource for, and communicate effectively with Providers and clinic staff, the patient(s), and the patient’s family/pertinent persons regarding patient plan of care and critical information as appropriate

Ensure continuity of care for CommuniCare OLE patients between internal CommuniCare OLE services, programs, and Providers while providing clear and timely communication

Participate in interdisciplinary team meetings to discuss complex patient cases, work-flow and/or processes related to operations and the Integrated Care Model

Follow department, scope-specific and CommuniCare OLE guidelines, policies, procedures, and protocols for patient care and service quality: Make recommendations to Providers on medication/insulin needs and/or adjustments and adjust insulin as for patients with Diabetes per standing orders/protocols

Provide discipline-specific input for the development, approval, implementation, and annual revisions of Comprehensive Perinatal Services Program (CPSP) Nutrition and/or Health Education protocols and serve as discipline-specific expert consultant to the CPSP staff as assigned

Ensure correct and timely documentation and billing in the patient’s electronic medical record, utilize appropriate organizational electronic communication systems, and communicate by other appropriate means on patient plan of care

Collaborate with and refer patient to external services, programs, agencies and Providers as warranted

Submit Treatment Authorization Requests (TAR) to insurance companies as warranted

Coordinates Nutrition and/or Health education related program needs assessment and development, implements and delivers program content, and coordinates interdisciplinary program support based on department and OLE Health needs

Take initiative in developing/revising, implementing, and promoting Nutrition and/or Health Education related educational materials, curricula, policies, procedures, protocols, templates, and marketing materials; organize and stock materials as necessary

Participate in new staff/student/intern competence and performance development and community outreach events and community education as needed

Assume responsibility for ongoing professional development and continuing education by review of literature and professional journals, attend conferences/programs to update knowledge and skills, and continuously seek to improve and maintain professional competence

Seek out additional learning as the organization, department, and technology evolves/changes as well as to accommodate patient needs

Participant in and attend at all meetings as requested, including but not limited to department staff meetings, pod/site meetings, provider meetings/trainings, and program subcommittees

Identify Nutrition and/or Health Education research opportunities and/or participate in research

Promotes and shares knowledge via mentorship/preceptorship consistent with research and evidence-based practice, policies, and protocols

Perform other duties as assigned