Position Summary
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.

We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. Our organization promotes autonomy through a Monday-Friday working schedule and flexibility as you coordinate the care of your members. Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and medically complex members. Develops a proactive course of action to address issues presented to enhance the short and Long term outcomes as well as opportunities to enhance a member's overall wellness through integration.

Case Management Coordinators will determine appropriate services and supports due to member'shealth needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilledproviders, Condition management information, Medication review, Community resources andsupports.


Duties
Coordinates case management activities forMedicaid Long Term Care/ComprehensiveProgram enrollees. Utilizes critical thinking andjudgment to collaborate and inform the casemanagement process, in order to facilitateappropriate healthcare outcomes for membersby providing care coordination, support andeducation for members through the use of caremanagement tools and resources.
Conducts comprehensive evaluation of Members using care management tools andinformation/data review Coordinates andimplements assigned care plan activities andmonitors care plan progress
Conducts multidisciplinary review to achieve optimal outcomes
Identifies and escalates quality of care issues through established channels
Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve 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 knowledgeably participate with their provider in healthcare decision-making Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Experience
Case management experience required
Long term care experience preferred
Microsoft Office including Excel competent

Preferred Qualifications:
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Effective communication skills, both verbal and written
Managed Care experience
Computer proficiency in Microsoft Word, Excel, and Outlook required
Case management and discharge planning experience

Education
Bachelor's degree required - No Nurses. SocialWork degree or related field


Qualifications:
FLUENT Bilingual Spanish/English REQUIRED (both reading and speaking and writing)
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written

Notes:

Monday - Friday: 8 am - 5 pm
safety sensitive

This role will require 50-75% travel for face-to-face visits with members
Schedule is Monday-Friday, 8:00am-5:00pm, standard business hours