Case Management Coordinator

Candidate will travel approximately 75% of the time within the region seeing Members at home, in assisted living facilities and nursing homes.

Description:

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'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.

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.

Duties

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.

Experience

One year Case management experience A MUST Case Management Certificate (Preferred)

Long term care experience (Preferred)

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

Preferred Qualifications:

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. Social work degree or related field preferred.

Notes:

Monday-Friday 8am-5pm EST

Training will be conducted remotely via Microsoft Teams for approximately 4-6 weeks.

Candidate will travel approximately 75% of the time within the region seeing Members at home, in assisted living facilities and nursing homes.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status