Job Description

Position Summary:

Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively

manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues

Duties:

Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.

Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.

Conducts comprehensive evaluation of Members using care management tools and information/data review

Coordinates and implements assigned care plan activities and monitors care plan progress

Conducts multidisciplinary review to achieve optimal outcomes

Identifies and escalates quality of care issues through established channels

Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs

Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health

Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices

Helps member actively and knowledgeably participate with their provider in healthcare decision-making

Monitoring, Evaluation and Documentation of Care:

Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Experience:

One year Case management experience A MUST / Case Management Certificate ( Preferred)

Long term care experience (Preferred)

Microsoft Office including Excel competent

Bilingual - Spanish / English (required)

Education:

Bachelor's degree required - No nurses. Social work degree or related field.

Job Tags

Full time,

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