Under the general supervision of the Director of Health Services, the position is responsible for collaborating with a 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 patients/families and healthcare personnel to ensure timely and effective care. The Case Coordinator will be accountable for understanding all aspects of Leon Health’s Care Management Program.
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
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 & Skills
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)