Long Term Care Coordinator - Health Plan

Location: Miami, FL
Date Posted: 02-06-2018
Bilingual Care Management Coordinator- Managed Long Term Care
Miami, FL (Field position - Travel in Miami/Dade/Monroe Counties)
** This is a Full Time, Benefits Available, CONTRACT position, expected to last 2 months, or longer! **
* Offers mix of Telephonic / In Office & Field / In Person Case Management, traveling to member homes and area SNFs! *
** Great for those who love variety and limited local travel (mileage reimbursed)!! *
Your Job Summary:
Care Management Coordinators are the front-lines of providing excellence in customer care to both internal and external clients.  They are responsible for ensuring that appropriate member treatment plans are followed and proactively identifying ways to improve the health of our members and meet quality goals.  The position primarily supports Medical Management functions related to Case Management, Utilization Review, and/or Quality Improvement activities.  The Coordinator also has direct contact with members or their families, and medical providers throughout the region, primarily for the purpose of scheduling support.  The Care Management Coordinator plays an integral part in following up on the assigned nursing plan of care, ensuring members are actively engaged in follow-up care linking them to the necessary resources, options, and coordination for a healthy care outcome. The Coordinator will function as a form of liaison between the health plan, the contracted provider organization, and the health plan members.  They will facilitate communication between all three parties to assist in the direct coordination of care for members. 

Your Reward:  

Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health.

Your Background:  
Requires an education level of at least a High School diploma or GED.  Associates or Bachelor Degree preferred.
Requires exceptional phone / customer service skills, as well as very strong computer user skills.
At least 3-5 years’ Care Coordination experience, preferably in home health, long term care, provider office setting, or other healthcare support role with heavy computer & phone use.
Requires 1 or more years at a Managed Care Organization (Health Plan, IPA/Medical Group, HMO, TPA/MSO, etc).
Requires basic to intermediary familiarity with Medical terminology (1-3 years direct experience).
Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
Knowledge of health care delivery system, Medicaid/Medicare and related state programs is required.
Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
Must have a minimum of 30-40 wpm typing with a high level of accuracy.
Ability to work regularly scheduled shifts within hours of operation 
Requires Bilingual (English and Spanish) in written and spoken communications.
Your Duties: 
  • Coordinates follow-up care plans by scheduling needed appointments or enrolling member in related programs
  • Assesses member compliance with medical treatment plans, identifying any barriers and coordinating resolution to ensure that members receive appropriate care, at the appropriate level, in a timely manner
  • Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
  • Gathers clinical information regarding individual cases and determines appropriate Medical Management area to refer call or assign case, such as Case Management, Utilization Review, Quality Improvement, and/or Appeals and Grievances, etc
  • Provides information regarding network providers or general health plan or program information when requested
  • As needed, administratively assist with the review of complex cases
  • In conjunction with case management nurse and providers, makes recommendations to adjust or modify treatment plan and/or determines need for additional services
  • Serves as a liaison between the Medical Management departments (CM/UR/QI, etc) and Health Plan Operations or other internal departments
  • Investigate inquiries, follow up on them, and document actions required to service inquiry
  • Assists customers in navigating relevant websites and encourage and reassure them to become self-sufficient
  • Identifies and refers members to appropriate local, state or federal programs
  • Reports any relevant trends as opportunities to impact quality goals and makes appropriate process change recommendations
  • Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues 
  • Provide education and status of previously submitted pre-authorizations or pre-determination requests
  • NOTE: This position is NOT involved in any activity which requires advanced interpretation of clinical information, or any other duties that requires clinical licensure by the state
Associate Search Consultant
CareNational Healthcare Services
480.448.6498 (CALL – TEXT – FAX)
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