Care Coordinator

Care Coordinator, LSW (MSHO)Winona, MinnesotaBluestone delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs.Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients' chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period.Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida.Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day. Bluestone has been named to the Star Tribune's Top Workplace list for the 14th year in a row! Bluestone also achieved Top Workplace USA 2021-2026! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary.Position OverviewJoin our team as a Care Coordinator where you will work with the senior population managing Department of Human Services (DHS) and Center for Medicare/Medicaid Services (CMS) required activities for Minnesota Senior Health Options (MSHO/MSC+) members living in the community and assisted living facilities. In this position, you will work from home, but regularly travel your local area to serve the needs of your members and your community. Schedule: Full time position, day shift hours, no evenings, weekends or holidays. Hours are 8am to 5pm Monday thru Thursday & 8am to 3pm on Fridays. Location: ~50-70% travel throughout the Winona, MN area and ~30-50% remote work. Salary Range: $65,000 - $75,000. Salary commensurate with experience. $2,500 Sign-On Bonus: Receive $1,000 after your first 90 days, and an additional $1,500 upon reaching your one-year anniversary.Responsibilities:As a Care Coordinator, you will manage member caseloads within your assigned geographic area. This includes:Coordinating face-to-face visitsManaging the Elderly WaiverConducting annual assessments including Personal Care Assistance (PCA) assessments for community members and customized living tools for members residing in Assisted LivingsReviewing current health needs, identifying goals, and developing individualized care plansHelping connect members with community and state resources and servicesCompleting required documentationCollaborating with medical care teams to ensure health care quality measures are met and use utilization management tools to meet value-based goalsSupporting members during transitions of care as well as collaborating with their care team to ensure a safe discharge and follow up planQualifications:Education/Certification/Experience:Current MN Licensed Social Worker (new grads encouraged to apply)OR Minnesota Registered Nurse licenseOne or more years of experience working with the geriatric or certified disabled population in case management/care coordination, Home Care, Group Homes, Nursing Homes, TCU or Assisted Living settings preferredMust have a valid driver's licenseKnowledge/Skills/Abilities:Ability to work independentlyAccess to a private and compliant home office spaceCreative problem-solving skillsAppreciation for working with diverse populationsProven ability to communicate effectively with strong verbal skillsExcellent interpersonal and customer service skillsDemonstrated compatibility with Bluestone's mission and operating philosophiesDemonstrated ability to read, write, speak, and understand the English languageBluestone Benefits:Health InsuranceDental InsuranceVision Materials InsuranceCompany paid Life InsuranceCompany paid Short and Long-term DisabilityHealth Savings Account (with employer contribution)Flexible Spending Account (FSA)Retirement plan with 4% matching contributionsNine (9) paid holidays for office closures plus one (1) floating holidayThree weeks (15 Days) Paid Time Off (PTO)Mileage reimbursement program for field employeesCompany sponsored cell phone, laptop and scrubsRegular business hoursPay Transparency$65,000 - $75,000 USD Bluestone Physician Services