Hybrid Care Coordinator, Massachusetts

Job Summary The Care Coordinator - Massachusetts is the primary point of contact for a stratified panel of members whose role is to assist enrollees in navigating their health care, providing care planning and coordination of services, ensuring timely service delivery and prompting continuity of care through coordinated outreach and engagement with members and providers. The role is responsible for routine enrollee outreach, including community-based visits, telephonic or virtual visits, documenting service activities and supporting administrative functions that enhance member satisfaction. Location requirement: Seeking candidates residing in Worcester, Springfield and North Shore Areas. Essential Functions Serve as the first point of contact for enrollees, including assisting with understanding health plan processes, appeals and grievances and removing barriers to needed services. Conduct routine outreach to members and providers to confirm service details, coordinate services with long‑term services and supports teams, and serve as a health plan subject matter expert. Provide in‑person visits to enrollees at least annually, with member consent. Maintain open lines of communication with enrollees as needed based on enrollee preferences. Maintain accurate and timely documentation and internal systems to ensure visibility across teams and continuity of service. Coordinate provider and member scheduling efforts, support high‑volume outreach campaigns, and ensure task completion across multiple systems. Identify potential social support or community‑based needs. Lead the interdisciplinary care team (ICT) for a stratified panel of members, collaborating with internal and external team members to create an enrollee‑centered care plan. Provide education on plan benefits and service options. Serve as a support resource for enrollees and providers, escalating concerns by coordinating responses and ensuring issues are routed or addressed promptly. Collaborate with clinical care managers, behavioral health clinicians, community health workers, providers, and external partners to ensure smooth communication and continuity across care activities. Gather and document service‑related information during member interactions to support care coordination, service planning, or referral processes. Maintain accurate documentation and maintenance of centralized enrollee records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners. Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements. Ensure enrollees follow up with providers, including assistance with appointment scheduling and verification of transportation. Facilitate communication and information exchange with the member, their providers, and community supports. Perform any other job‑related duties as requested. Education and Experience High School or GED required. Two (2) years of experience in healthcare, customer service, or a related industry required. Competencies, Knowledge and Skills Basic proficiency with Microsoft Office Suite (Outlook, Word, Excel). Knowledge of Medicaid, Medicare and Managed Care preferred. Customer service focus with exceptional listening, written and verbal communication skills. Professional phone etiquette. Ability to multitask using a variety of computer applications. Strong organizational skills. Effective problem‑solving skills with attention to detail. Ability to work independently and within a team environment. Understanding and supportive of the managed care concept. Adaptable to a constantly changing environment. Ability to type and talk (telephonically) simultaneously. Licensure and Certification Must have a valid driver’s license, vehicle and verifiable insurance. Employment is conditional pending a successful driver’s license record check. If the results are unacceptable, the offer may be withdrawn or employment terminated. Influenza vaccination is a requirement. Annual proof of vaccination during the influenza season (October 1 – March 31) is required. Employment may be terminated if vaccination is not obtained within thirty (30) days of hire during the influenza season. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs as required by state law. Working Conditions Mobile position requiring regular travel to various locations, including homes and offices. Exposure to typical weather conditions and requirement to stand and/or sit for long periods. Must reside in the same territory assigned; exceptions may be considered for business need. May be required to travel greater than 50% of the time. Must use general office equipment (telephone, photocopier, fax machine, computer). Flexible hours, including possible evenings and/or weekends when needed to serve members. Compensation Hourly salary range: $47,400.00 – $76,000.00. In addition to base compensation, employees may qualify for a bonus tied to company and individual performance. The position is considered highly invested in employee health and rewards with a comprehensive total rewards package. Equal Opportunity CareSource is an Equal Opportunity Employer. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. #J-18808-Ljbffr CareSource