Under the general supervision of the Director of Health Services, the position is responsible for collaborating with a plan Case Manager (RN) on the ongoing assessment, planning, and evaluation of members in the Care Management Program(s). The incumbent acts as a liaison between patient/family and healthcare personnel to ensure that the necessary care is provided promptly and effectively. The Case Coordinator will be accountable for understanding all aspects of the Leon Health’s Care Management Program.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Oversee non-clinical and administrative staff
- Responsible for MOC activities, including processing of HRA’s, individualized care plan,
- interdisciplinary care team and care transitions
- Manage D-SNP members collaboratively with a plan Registered Nurse, in particular those belonging to
- the most vulnerable population
- Identify needs and create a care plan, with the input of the member’s interdisciplinary care team, to
- help the member achieve their goals
- Support ongoing member engagement
- Address the member’s individual needs, strengths, preferences, and goals
- Educate members on their conditions and promote self-management skills including the understanding signs and symptoms that indicate a need to contact the PCP, and when it is appropriate to seek urgent or emergent care
- Support medication adherence
- Engage in member-centric discharge planning
- Ensure timely initiation of post-discharge services and care
- Link members to available community supports
- Coordinate with case managers and providers
- Communicate and coordinate with the member and their caregivers, practitioners, behavioral health
- providers, disease management staff, and other members of the ICT to ensure that the member’s
- needs are addressed, and care transitions are communicated
- Review and coordinate member cases with Medical Director(s)
- Supports standards that are consistent community and nationally recognized evidence-based practice
- Works collaboratively with Utilization Management staff to quickly and efficiently address any Care
- Management or Utilization Management concerns or barriers
- Identifies process improvement opportunities within Care Management
- Works in partnership with plan compliance and clinical oversight to support Medicare and Medicaid (if
- appropriate) grievance and appeals processes.
- Assists in peer training as needed.
- Participates in Quality Improvement and Risk Management activities as requested.
- Participates in training and in-service education as required.
- Complies with Leon Health’s policies and procedures and maintains confidentiality of patient’s medical records in accordance with state and federal laws.
- Maintains open channels of communication with other company departments.
- Answers all inquiries in a professional and courteous manner.
- Rotating on call-weekends.
- Participates in department, clinic and other meetings as requested.
- Complies with the organization's policies and procedures and maintains confidentiality in accordance with state and federal laws.
- Participates in special projects and performs other duties as assigned.
QUALIFICATIONS
- Minimum of one (1) year of experience in Case Management
- Problem solving proficiency; the ability to systematically analyze problems, draw relevant conclusions
- and devise appropriate courses of action
- Process/systems skills with the ability to work with data for data-driven decision making and process
- improvements
- Medicare and/or Medicaid managed care experience
KNOWLEDGE AND SKILLS REQUIRED:
- Knowledge of Dual Eligible Special Needs Plans, Centers for Medicare and Medicaid Services
- (CMS), and Florida Medicaid
- Understanding of Case Management best practices
- Strong verbal and electronic communication skills
- Supports positive employee relations and customer experience
- Understanding of Microsoft Office Products and other appropriate software platforms
- Ability to work autonomously with self-direction
EDUCATION
Proof of completion of Licensed Practical Nurse (LPN) accredited program. Foreign Medical Graduate (FMG)
LANGUAGE SKILLS
Bilingual English/Spanish fluency.
CERTIFICATES, LICENSES, REGISTRATIONS
Licensed Practical Nurse (LPN) accredited program, Foreign Medical Graduate (FMG)
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