Bluestone Physician Services
Healthcare
CareCoordinator,RN(MSHO)
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Care Coordinator, RN (MSHO) at Bluestone Physician Services. Skills: Care coordination, Geriatric population management, DHS activities, CMS activities. Manage member caseloads. Coordinate face-to-face visits”
What You'll Achieve.
Meet health care quality measures; Meet value-based goals
Industry & Context.
Creative problem-solving
Regular travel required, Access to private home office
What They're Looking For.
Must Have
Current Minnesota Registered Nurse license, MN Licensed Social Worker, Valid driver's license
Nice to Have
1+ years geriatric/disabled population experience, Case management/care coordination experience, Home Care experience, Group Homes experience, Nursing Homes experience, TCU experience, Assisted Living experience
What You'll Do.
Manage member caseloads
Coordinate face-to-face visits
Manage the Elderly Waiver
Conduct annual assessments
Develop individualized care plans
Connect members with resources
Complete required documentation
Collaborate with medical care teams
Support members during transitions of care
Ensure safe discharge and follow up
How You'll Work.
Team & Collaboration
Multidisciplinary care teams; Healthcare providers
Communication Scope
Verbal skills
Full Job Description
Bluestone delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs. Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients’ chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period. Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida. Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day. Bluestone has been named to the Star Tribune's Top Workplace list for the 13th year in a row! Bluestone also achieved Top Workplace USA 2021-2025! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary. Position Overview: Join our team as a Care Coordinator where you will work with the senior population managing Department of Human Services (DHS) and Center for Medicare/Medicaid Services (CMS) required activities for Minnesota Senior Health Options (MSHO/MSC+) members living i
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