Care Coordinator IV

Centene Corporation•Las Vegas, NV

1d•$23 - $39•Hybrid

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Leads the care coordination team to support care management activities to assigned members to ensure appropriate services are delivered by providers and ensure continuity of care across services. Serves as a liaison alongside care managers and providers to ensure proper coordination of care for the member and interacts with members by performing member outreach telephonically or through home-visits. This is a hybrid position with occasional provider visits, however candidate would need to reside in either Tucson or Tempe Arizona or Las Vegas, Nevada. Leads and oversees outreach to members via phone or home visits to engage member and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for both the member and provider throughout care/service, as appropriate Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed Provides continuous support and insight and serves as support on various highly complex member and/or provider inquiries, requests, or concerns related to care plans/service plans Develops advanced knowledge of care management services including responding to some complex or escalated issues Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care May oversee service assessments/screenings for members with complex needs and documents the member’s care needs Documents, maintains, and reviews member records in accordance with state and regulatory requirements and provide to providers as needed Works with care management team with triaging, adjusting, and escalating highly complex requests to management Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager Provide education on benefits and resources available May assist with training and development needs Performs other duties as assigned. Complies with all policies and standards.

Requirements

Requires a High School Diploma or GED.
Requires 4+ years of related experience

Nice To Haves

Prefer intermediate Excel skills
Knowledge of HEDIS measures is a plus

Responsibilities

Leads and oversees outreach to members via phone or home visits to engage member and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for both the member and provider throughout care/service, as appropriate
Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed
Provides continuous support and insight and serves as support on various highly complex member and/or provider inquiries, requests, or concerns related to care plans/service plans
Develops advanced knowledge of care management services including responding to some complex or escalated issues
Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care
May oversee service assessments/screenings for members with complex needs and documents the member’s care needs
Documents, maintains, and reviews member records in accordance with state and regulatory requirements and provide to providers as needed
Works with care management team with triaging, adjusting, and escalating highly complex requests to management
Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards
Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager
Provide education on benefits and resources available
May assist with training and development needs
Performs other duties as assigned.
Complies with all policies and standards.