Care Coordinator- CISC

About the role

Careers in this role involve coordinating care for individual clients within identified populations through assessments, care planning, implementation, coordination, monitoring, and evaluation to achieve cost-effective and high-quality outcomes. Duties can be performed virtually or face-to-face depending on contractual requirements.

Responsibilities

• Promote appropriate use of clinical and financial resources to enhance care quality and member satisfaction.
• Aid in the orientation and mentoring of new team members.
• Provide care coordination for members with behavioral health conditions requiring intensive interventions and oversight, utilizing multiple clinical, social, and community resources.
• Conduct in-depth health risk assessments and comprehensive needs assessments covering psycho-social, physical, medical, behavioral, environmental, and financial aspects.
• Create, document, and implement care plans to address social, physical, mental, emotional, spiritual, and supportive needs.
• Act as a member’s advocate by identifying and addressing gaps in care.
• Ongoing monitoring of the care plan to evaluate its effectiveness and make adjustments as needed.
• Educate providers, staff, members, and families about the care coordination role and health strategies, focusing on a member-focused approach.
• Facilitate a team approach to care coordination and service delivery, collaborating with interdisciplinary care teams to ensure appropriate interventions and cost-effective care.
• Collaborate with interdisciplinary care teams to address care issues, member needs, and disease processes, including medical, behavioral, social, community-based, and long-term care services.
• Utilize licensed care coordination staff for complex cases and assist members with questions and concerns regarding care, providers, or the delivery system.
• Maintain professional relationships with external stakeholders, such as inpatient, outpatient, and community resources.
• Generate reports aligned with care coordination goals.

Requirements

• 3-5 years' experience in Social Work, Nursing, or Healthcare-related fields, or relevant experience in lieu of a degree.
• Experience in utilization management, quality assurance, home or facility care, community health, long-term care, or occupational health.
• Experience in analyzing trends based on decision support systems.
• Business management skills including cost/benefit analysis, negotiation, and cost containment.
• Knowledge of referral coordination to community and private/public resources.
• Ability to interpret data and make decisions that require significant analysis and investigation.
• Effective verbal and written communication skills.
• Ability to work well with clinicians, hospital officials, and service agency contacts.

Qualifications

• GED, High School Education.
• Associate, Bachelor's Degree in related field.
• Licensed Case Manager (CCM).
• Licensed Clinical Social Worker (LCSW).
• Registered Nurse (RN), state and/or compact state licensure.

Skills

• Interpretation of data.
• Decision-making in complex situations.
• Team collaboration and care coordination.
• Communication and advocacy skills.
• Resource management and cost containment.

Benefits

The position offers a comprehensive benefits package, including health, life, voluntary, and other perks designed to enhance physical, mental, emotional, and financial wellbeing. Magellan is committed to providing an equal opportunity employment environment and is a tobacco-free workplace.