[Hiring] Clinical Care Navigator @Mindlance

Role Description

Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

• Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome.
• Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care.
• Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as employment, education, housing, food, participant direction, independent living, justice, foster care based on service assessment and plans.
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner.
• May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate.
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
• May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate.
• May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits.
• Other duties or responsibilities as assigned by people leader to meet the member and/or business needs.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Requires a Bachelor’s degree and 2 – 4 years of related experience.
• Graduate from an Accredited School of Nursing if holding clinical licensure.
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Requirements

• Current state’s clinical license preferred.
• Over 5 years of experience working directly with the ABD (Aged, Blind, and Disabled) population in call center environments, Medicaid programs, and Managed Care Organizations (MCOs).
• Skilled in supporting individuals with disabilities and vulnerable populations managing chronic or complex health conditions.
• Demonstrated expertise in providing care coordination for children, young adults, and other high-need groups within the past three of the last five years.
• Good attendance, call center background; worked with MCO insurance.

Benefits

• Self-starters, eager to learn, great customer service.
• Each day, they will interact with different members, learning from them and assisting with their individual needs.

Company Description

• Health Plan.
• Call Center.
• Would be working with MSC Department and assisting in taking calls for our STAR PLUS member.
• Team is to cover and answer calls that come in through call center.
• This is to cover the SCs who are out in LOA, FMLA and the openings we have open.