Care Management Coordinator

Care Management Coordinator

Requirements

• 2 years of related professional experience includes acting as a care manager, rehabilitation specialist, health specialist, social services coordinator etc.
• Experience working with a diverse population required
• Must reside in the State of Florida
• Bachelor’s degree in social work, psychology, or a related social services field is required

Responsibilities

• Uses care management tools and information to complete a comprehensive evaluation of members and recommends an approach to case resolution by determining member needs in alignment with their benefit plan and available internal and external programs and services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an optimum level of health.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Using a holistic approach consults with clinical care managers, leadership, medical directors and other physical/behavioral health support staff and providers to overcome barriers to meeting member goals and objectives.
• Presents cases at case conferences/rounds to obtain multidisciplinary review in order to achieve optimal outcomes.
• Works collaboratively with the members’ interdisciplinary care team.
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.
• Identifies and escalates quality of care issues through established channels.
• Monitors, evaluates and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation).
• Educates members about available resources and services such as Florida value-added benefits and assisting the member in accessing those resources and services.
• Facilitates clinical hand offs during transitions of care.

Preferred Qualifications

• Managed Care experience preferred
• Bilingual Spanish or Creole preferred