MMA Care Manager

divh2Mma Care Manager/h2pWe are seeking an MMA Care Manager to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations./ppThe MMA Care Manager plays a critical role in coordinating and managing comprehensive care plans for members enrolled in Managed Medical Assistance (MMA) programs. This position focuses on improving member outcomes by assessing individual health needs, facilitating access to appropriate healthcare services, and ensuring adherence to treatment protocols. The Care Manager acts as a liaison between member, healthcare providers, and insurance entities to optimize care delivery and resource utilization. By monitoring member progress and addressing barriers to care, the role contributes to enhanced quality of life and reduced hospital readmissions. Ultimately, the MMA Care Manager supports the organizations mission to provide high-quality, member-centered care within the Medicare Advantage framework./ppMinimum Qualifications:/pulliBachelors degree in Nursing, Social Work, Public Health, or a related healthcare field./liliCurrent and valid professional licensure or certification relevant to care management (e.g., RN, LCSW)./liliMinimum of 3 years experience in case management, care coordination, or a related healthcare role./liliStrong knowledge of Medicare Advantage programs, healthcare regulations, and care management best practices./liliProficiency in electronic health records (EHR) systems and care management software./liliRelevant experience may substitute for the educational requirement on a year-for-year basis./li/ulpPreferred Qualifications:/pulliMasters degree in Nursing, Social Work, Public Health, or a related healthcare field./liliCertified Case Manager (CCM) or Accredited Case Manager (ACM) certification./liliExperience working specifically with Medicare Advantage populations./liliAdvanced degree in healthcare administration, nursing, or social work./liliFamiliarity with population health management and quality improvement methodologies./liliBilingual abilities to effectively communicate with diverse member populations./li/ulpResponsibilities:/pulliConduct thorough assessments of members health status, medical history, and social determinants of health to develop personalized care plans./liliCoordinate with physicians, specialists, and other healthcare professionals to ensure timely and effective delivery of medical services./liliMonitor member adherence to prescribed treatments and medications, providing education and support to encourage compliance./liliIdentify and address potential gaps in care, including arranging for additional services such as home health, rehabilitation, or community resources./liliMaintain detailed documentation of care plans, member interactions, and outcomes in compliance with regulatory and organizational standards./li/ul/div