Job ID 1493073
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. Our organization promotes autonomy through a Monday-Friday working schedule and flexibility as you coordinate the care of your members. Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the members overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and medically complex members. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a members overall wellness through integration. Case Management Coordinators will determine appropriate services and supports due to members health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports. ; Qualification Must Have CVS Caremark Requirements
Prior CVS/Aetna work experience?
Verifyable High School Diploma or GED Required
Yes Is this request for Peak Season? Select applicable value
_N/A – Not RAMP Related
Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
Conducts comprehensive evaluation of Members using care management tools and information/data review
Coordinates and implements assigned care plan activities and monitors care plan progress
Conducts multidisciplinary review to achieve optimal outcomes
Identifies and escalates quality of care issues through established channels
Utilizes negotiation skills to secure appropriate options and services necessary to meet the members benefits and/or healthcare needs
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve 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 knowledgeably participate with their provider in healthcare decision-making
Monitoring, Evaluation and Documentation of Care:
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Case management experience required
Long term care experience preferred
Microsoft Office including Excel competent
Location: Work from Home. Candidates must reside in Miami-Dade County, FL.
Training will be conducted remotely via Microsoft Teams for approximately 1-2 weeks.
Candidate will travel approximately 75% of the time within the region seeing
Members at home, in assisted living facilities and nursing homes.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written
Bachelor’s degree required- No Nurses. Social work degree or related field.
What days & hours will the person work in this position? List training hours, if different.
Monday – Friday: 8 am to 5 pm
Type of Start
Program Office – Point Of Contact
Is this an in-person, patient-facing role?
Remote with future possibility of onsite