Care Coordinator

Job Description

Job Description

Must-Haves • 2 years’ experience in behavioral health, social services, or appropriate related field equivalent to program focus • Managed Care experience • Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually (MS Office – Teams – Etc)

Day-to-Day Responsibilities The Clinical Care Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. They facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

Responsibilities include: Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order 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.