Case Management Coordinator

Our client, is a Retail Pharmacy company, is looking for a Case Management Coordinator for their Cutler Bay County, FL location.


Responsibilities:

• 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
• 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's health needs; including but not limited to:
• Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.
• Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
• Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by
• providing care coordination, support and education for members through the use of care management tools and resources.
• Conducts comprehensive evaluation of Members using care management tools and information/data review Coordinates and implements assigned care plan activities and monitors 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.

• We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team.
• Verifyable High School Diploma or GED Required
• Case management experience required
• Long term care experience preferred
• Microsoft Office including Excel competent
• Members at home, in assisted living facilities and nursing homes.
• Bachelor's degree required - No Nurses.
• Social Work degree or related field.

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities