- Manages a caseload as outlined by Care Management Leadership.
- Contacts enrollee at predetermined intervals based on stratification level or more frequently, as needed.
- Conducts face-to-face visits at a frequency determined by the enrollee's assigned stratification level or more if needed, with each enrollee/caregiver in their homes, physician's offices, or other mutually agreed upon locations.
- Assesses enrollees on enrollment and at intervals determined by the enrollee's stratification level to identify needs/barriers and close gaps in care.
- Completes routine care coordination and care management activities with attention to quality, timeliness and in compliance with company policy and national standards.
- Consults with SeniorCare Manager to review and prioritize cases, set objectives, identify, and report potential risk and utilization concerns.
- Seeks advice from Senior Care Manager or other designated person with expertise in specialty areas when necessary.
- Accurately and timely documents enrollee findings and interactions according to organizational policy.
- Understands and abides by Company Confidentiality policy and procedure regarding enrollee specific information.
- Participates in disposition and discharge planning activities. Contributes to the discharge plan in a timely manner, taking into consideration enrollee/family/significant others and match to healthcare resources.
- Clearly communicates verbally and in writing.
- Assists assigned enrollees and their caregivers in understanding the importance of EPSDT and compliance with all health services. Strives to achieve target rate of compliance for preventive medical and dental services.
- Applies advanced knowledge of conditions of target population/standard approaches to care management and care coordination to assigned enrollees.
- Receives and reviews reports of visits by vendors or contracted providers to enrollees receiving services and facilitates coordination of follow-up care, as needed.
- Refers enrollee/caregiver to appropriate vendor(s) on DME/assistive technology use. Educates on medication administration, about their conditions, and techniques for self- management within the scope of license. Refer, as needed, to appropriate vendor for additional education.
- Assist enrollees in planning for transitions of care to include but not limited to transitioning from Early Intervention to DCPS; from pediatric to adult providers; transitioning out of the health plan when the enrollee ages out or is dis-enrolled for any reason; from outpatient to inpatient or the reverse; and entering or exiting the custody of CFSA, DYRS or any type of institutional care.
- Enters authorizations for services requiring authorization by Care Management staff.
- Uses communication skills which promote understanding and collaboration with enrollees and their families, providers and others.
- Maintains professional, courteous and customer focused demeanor in all interactions.
- Demonstrates knowledge of medical terminology and healthcare delivery systems.
- Applies time management and organizational skills effectively.
- Three to five years of related experience in managed care and /or care management
- Three to five years of experience in clinical or community resource settings
- Effective verbal and written communication skills
- Bilingual (Spanish speaking) preferred
- Familiar with medical terminology
- Familiarity with computer systems and applications, particularly in Microsoft Office suite
- Strong organizational skills
- Ability to interpret and apply departmental requirements
- Ability to make sound decisions and use good judgment
- Ability to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
- Ability to participate in professional, multidisciplinary meetings to include internal and external staff meetings
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Clinical Care Coordinator - Silver Spring, United States - Medicalincs, LLC
Description
Job Description
Job DescriptionSalary:Medicalincs is seeking clinical care coordinators (licensed Clinical Social Worker) for its client based in the District of Columbia. This position is mostly remote.
RESPONSIBILITIES:
QUALIFICATIONS:
License/Certifications:
Licensed in DC as a Social Worker (LICSW), Registered Nurse (RN),
Certification as a Case Manager preferred.
Required Education:
Associates degree required. Bachelor's degree preferred.
Moderate degree of mental/visual stress involved. Concentrated periods of time spent using PC keyboard and viewing monitor. Will work some weekends, evenings or early hours to accommodate member needs.
Medicalincs is an Equal Opportunity Employer and does not discriminate on the basis of race, creed, color, religion, gender, sex, sexual orientation, gender identity, pregnancy, national origin, citizenship status, age, disability, medical condition, genetic information, marital status, status as a covered veteran, military discharge status, criminal records that have been sealed or expunged, arrest records not resulting in conviction or any other characteristic protected by federal, state and/or local law.
