[Hiring] Case Management Coordinator @Our client

Role Description

Our client, a Retail Pharmacy company, is looking for a Case Management Coordinator for their Cutler Bay County, FL location.

• Fluent Bilingual Spanish/English required (both reading and speaking and writing)
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Effective communication skills, both verbal and written
• Promotes autonomy through a Monday-Friday working schedule and flexibility as you coordinate the care of your members.
• Responsible for telephonically and/or face-to-face assessing, planning, implementing, and coordinating all case management activities with members to evaluate their medical needs and facilitate overall wellness.
• Effectively manage a caseload that includes supportive and medically complex members.
• Develop a proactive course of action to address issues presented to enhance short and long-term outcomes and opportunities for overall wellness through integration.
• Determine appropriate services and supports based on member’s health needs, including but not limited to:
  • Prior Authorizations
  • Coordination with PCP and skilled providers
  • Condition management information
  • Medication review
  • Community resources and supports
• Coordinate case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
• Utilize critical thinking and judgment to collaborate and inform the case management process to facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education through care management tools and resources.
• Conduct comprehensive evaluation of Members using care management tools and information/data review.
• Coordinate and implement assigned care plan activities and monitor care plan progress.
• Conduct multidisciplinary review to achieve optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Utilize negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum health.
• Provide coaching, information, and support to empower members to make ongoing independent medical and/or healthy lifestyle choices.
• Help members actively and knowledgeably participate with their provider in healthcare decision-making.
• Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Qualifications

• Self-motivated, energetic, detail-oriented, highly organized, tech-savvy
• Verifyable High School Diploma or GED Required
• Case management experience required
• Long term care experience preferred
• Microsoft Office including Excel competent
• Bachelor's degree required - No Nurses
• Social Work degree or related field

Benefits

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities