HSS Coordinator - Remote in VA Market

About the role

The Care Coordinator will be the primary care manager for a panel of intellectually disabled/developmentally delayed members with low-to-high complexity medical/behavioral needs. Care coordination activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.

Responsibilities

• Engage members telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs
• Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
• Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan
• Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
• Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
• Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team

Required Qualifications

• Bachelor's degree in health or human services
• 1+ years of experience with MS Office, including Word, Excel, and Outlook
• 1+ year of experience working with members who have intellectual disabilities, and developmental delays, which may include those with physical disabilities and/or those who may have communication barriers
• Reside in Virginia

Preferred Qualifications

• LMHP OR RN/LPN OR QMHP OR LMSW OR LBSW OR MSW OR BSW
• CCM certification
• QIDP
• Experience working with Medicaid/Medicare population
• Long term care/geriatric experience
• Experience working in team-based care
• Background in Managed Care
• Driver's license and access to reliable transportation and the ability to travel within assigned territory to meet with members and providers

Pay

The salary for this role will range from $24.00 to $43.00 hourly based on full-time employment.