Care Coordinator - NM

About the role

This position will work primarily with justice / incarcerated and recently released from incarceration members. This position is remote within New Mexico.

Responsibilities

• 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.
• Affords regular review of the plan of care 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.
• Facilitates a team approach to the coordination and cost-effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.
• 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.

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.
• Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures.
• 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, High School Education - Preferred
• Associate, Bachelor's Degree - Preferred
• Certified Case Manager - Care Mgmt
• Licensed Clinical Social Worker - Care Mgmt
• Registered Nurse, State and/or Compact State Licensure - Care Mgmt

Skills

• Excellent communication skills
• Strong problem-solving abilities
• Ability to manage multiple tasks and prioritize effectively
• Proficiency in Microsoft Office Suite

Benefits

Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Pay

Salary Minimum $50,225
Salary Maximum $75,335

Schedule

The schedule is flexible and can be arranged to accommodate the needs of the employee and the organization.