Care Coordinator (Grants,NM/ Gallup,NM)

Coordinates care of individual clients with application to identified populations using assessment, care planning, implementation, coordination, monitoring, and evaluation for cost-effective and quality outcomes. Duties are performed virtually or face-to-face based on contractual requirements.

Responsibilities

• Promotes the appropriate use of clinical and financial resources 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 assessments and/or comprehensive needs assessments, including but not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
• Communicates and develops the care plan and serves as the 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 plans that provide appropriate resources to address social, physical, mental, emotional, spiritual, and supportive needs.
• Acts as an advocate for the member's care needs by identifying and addressing gaps in care.
• Performs ongoing monitoring of the plan of care to evaluate effectiveness and measures the effectiveness of interventions as identified in the member's care plan.
• Assesses and reviews the plan of care regularly to identify gaps in care and 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 the plan of care when necessary.
• Educates providers, supporting staff, members, and families regarding the care coordination role and health strategies with a focus on a member-focused approach to care.
• Facilitates a team approach to the coordination and cost-effective delivery of quality care and services.
• Collaborates with the interdisciplinary care plan team, which may include the 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 the delivery system.
• Maintains professional relationships with external stakeholders, such as inpatient, outpatient, and community resources.
• Generates reports in accordance with care coordination goals.

Requirements

• 3-5 years' experience in Social Work, Nursing, or a Healthcare-related field, 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 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.
• 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, including interpretation of data.
• Ability to make decisions that require significant analysis and investigation with solutions requiring 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.

Qualifications

• GED or High School diploma (required).
• Associate or Bachelor's degree (preferred).
• Valid Driver's License (required).
• Certified Case Manager (CCM) (preferred).
• Licensed Clinical Social Worker (LCSW) (preferred).
• Registered Nurse (RN), State and/or Compact State Licensure (preferred).

Pay

Salary range: $50,225 - $75,335. This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives.

Benefits

Magellan offers a comprehensive benefits package, including a broad range of health, life, voluntary, and other benefits and perks that enhance physical, mental, emotional, and financial well-being.