Care Coordinator
Location
New Mexico
Posted
8 days ago
Salary
$50.2K - $75.3K / year
Seniority
Senior
Job Description
Care Coordinator
Magellan Health
• Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes • Duties are performed virtually or face-to-face based on contractual requirements • Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction • Assists with orientation and mentoring of new team members as appropriate • Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources • Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters • Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately • Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes • Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs • Acts as an advocate for member`s care needs by identifying and addressing gaps in care • Performs ongoing monitoring of the plan of care to evaluate effectiveness • Measures the effectiveness of interventions as identified in the members care plan • Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes • Collects clinical path variance data that indicates potential areas for improvement of case and services provided • Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary • Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care • Facilitates a team approach to the coordination and cost-effective delivery to quality care and services • Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long-term care services • Utilizes licensed care coordination staff as appropriate for complex cases • Provides assistance to members with questions and concerns regarding care, providers or delivery system • Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources • Generates reports in accordance with care coordination goal.
Job Requirements
- 3-5 years' experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree
- Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required
- Experience in analyzing trends based on decision support systems
- Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment
- Knowledge of referral coordination to community and private/public resources
- Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data
- Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking
- Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols
- Ability to maintain complete and accurate enrollee records
- Effective verbal and written communication skills
- Ability to work well with clinicians, hospital officials and service agency contacts.
Benefits
- Comprehensive benefits package
- Health, life, voluntary and other benefits and perks
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