Care Coordinator – CISC
Location
New Mexico
Posted
14 days ago
Salary
$50.2K - $75.3K / year
Seniority
Senior
Job Description
Care Coordinator – CISC
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, (e.g., during transition to home care, backup plans, community-based services). • 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
- short-term incentives
- comprehensive benefits package
- broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing
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