About the position

Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties are performed virtually or face-to-face based on contractual requirements. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (e.g., during transition to home care, backup plans, community-based services). Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for member\`s care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan. Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary. Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost-effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member\`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long-term care services. Utilizes licensed care coordination staff as appropriate for complex cases. Provides assistance to members with questions and concerns regarding care, providers or delivery system. Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources. Generates reports in accordance with care coordination goal. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Responsibilities

• Coordinates care of individual clients
• Promotes the appropriate use of clinical and financial resources
• Assists with orientation and mentoring of new team members
• Provides care coordination to members with behavioral health conditions
• Conducts in depth health risk assessment and/or comprehensive needs assessment
• Communicates and develops the care plan and serves as point of contact
• Implements, coordinates, and monitors strategies for members and families
• Develops, documents and implements plan which provides appropriate resources
• Acts as an advocate for member\`s care needs
• Performs ongoing monitoring of the plan of care to evaluate effectiveness
• Measures the effectiveness of interventions
• Assesses and reviews plan of care regularly
• Collects clinical path variance data
• Works with members and the interdisciplinary care plan team to adjust plan of care
• Educates providers, supporting staff, members and families regarding care coordination role and health strategies
• Facilitates a team approach to the coordination and cost-effective delivery to quality care and services
• Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum
• Collaborates with the interdisciplinary care plan team
• Utilizes licensed care coordination staff as appropriate for complex cases
• Provides assistance to members with questions and concerns regarding care, providers or delivery system
• Maintains professional relationship with external stakeholders
• Generates reports in accordance with care coordination goal

Requirements

• 3-5 years' experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree.
• Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.
• Experience in analyzing trends based on decision support systems.
• Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.
• Knowledge of referral coordination to community and private/public resources.
• Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data.
• Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking.
• Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols.
• Ability to maintain complete and accurate enrollee records.
• Effective verbal and written communication skills.
• Ability to work well with clinicians, hospital officials and service agency contacts.
• Requires a valid in-state Driver License.

Nice-to-haves

• CCM - Certified Case Manager - Care Mgmt
• LCSW - Licensed Clinical Social Worker - Care Mgmt
• RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

Benefits

• short-term incentives
• comprehensive benefits package
• broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing