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Position Summary:

Care Management Coordinators (CMC) drive and support care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating).  The CMC utilizes critical thinking and judgment to collaborate and inform the care management/care coordination process to facilitate appropriate healthcare outcomes for assigned members. They provide care coordination, support and education for members using care management tools and resources.

Position Responsibilities:

• Uses care management tools and information to complete a comprehensive evaluation of members and recommends an approach to case resolution by determining member needs in alignment with their benefit plan and available internal and external programs and services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an optimum level of health.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.

• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Using a holistic approach consults with clinical care managers, leadership, medical directors and other physical/behavioral health support staff and providers to overcome barriers to meeting member goals and objectives.
• Presents cases at case conferences/rounds to obtain multidisciplinary review to achieve optimal outcomes.
• Works collaboratively with the members’ interdisciplinary care team.
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.
• Identifies and escalates quality of care issues through established channels.
• Monitors, evaluates and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation).
• Educates members about available resources and services such as Texas value-added benefits and assisting the member in accessing those resources and services.
• Facilitates clinical hand offs during transitions of care.

Reports to:  Manager, Clinical Health Services, Care Management

Required Qualifications:

• 2 years of related professional experience includes acting as a care manager, rehabilitation specialist, health specialist, social services coordinator, or licensed behavioral health professional in the State of Texas
• Must reside in Bexar/Tarrant County or surrounding area.
• Willing and able to travel 10-20% of their time to meet members face to face in the Bexar/Tarrant County or surrounding area.
• Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualification:

• Case management and discharge planning experience preferred.
• ·Managed Care experience preferred.
• Bilingual preferred – Spanish, Vietnamese
• Experience working with members with special healthcare needs(preferred – high risk population)

Education:

• Bachelor’s degree in social work, psychology, or a related social services field is required
• Or equivalent work experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $40.90

This pay range