Case Management Coordinator

Case Management Coordinator

Our client, a Retail Pharmacy company, is looking for a Case Management Coordinator for their Mid Miami Area, FL location.

Responsibilities:

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.

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

Requirements:

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

We are seeking self-motivated, energetic, detail-oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team.

Verifiable High School Diploma or GED Required:

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

Long term care experience {Preferred)

Microsoft Office including Excel competent

Bilingual - Spanish / English (required)

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

Bachelor's degree required - No nurses. Social work degree or related field preferred.

Why Should You Apply?

Health Benefits

Referral Program

Excellent growth and advancement opportunities