CISC Care Coordinator

Magellan Health • Albuquerque, NM

4d

About The Position

Coordinates care for individual clients and identified populations through assessment, care planning, implementation, coordination, monitoring, and evaluation to support cost-effective, quality outcomes. Duties may be performed virtually or face-to-face, as required by contract. The role promotes appropriate use of clinical and financial resources to improve care quality and member satisfaction, and may assist with orientation and mentoring of new team members.

Provides care coordination for members with behavioral health conditions requiring intensive interventions and oversight involving clinical, social, and community resources. Conducts in-depth health risk or comprehensive needs assessments covering psychosocial, physical, medical, behavioral, environmental, and financial factors. Develops and communicates care plans, serves as a point of contact to ensure services are delivered appropriately, and coordinates strategies and resources to address members’ needs and improve health and quality-of-life outcomes.

Advocates for members by identifying and addressing gaps in care, monitoring and evaluating care-plan effectiveness, reviewing plans for trends and opportunities for improvement, and collecting clinical path variance data. Works with members, families, and interdisciplinary care-plan teams to adjust plans when needed. Educates providers, staff, members, and families about care coordination and health strategies, and facilitates coordinated, cost-effective care across the continuum. Collaborates with caregivers, legal representatives, physicians, care providers, and ancillary services to address medical, behavioral, social, community-based, and long-term care needs. Maintains professional relationships with external stakeholders, assists members with care and delivery-system questions, maintains accurate enrollee records, and generates reports aligned with care-coordination goals. Additional duties may be assigned consistent with the intent of the role.

Requirements

• Three to five years of experience in social work, nursing, or a healthcare-related field, or relevant experience in lieu of a degree.
• Required experience in utilization management, quality assurance, home or facility care, community health, long-term care, or occupational health.
• Experience analyzing trends using decision support systems.
• Business management skills, including cost/benefit analysis, negotiation, and cost containment.
• Knowledge of referral coordination to community and private/public resources.
• Detailed knowledge of cost-effective care coordination, including the work to be done and the interpretation of related data.
• Ability to make decisions requiring significant analysis and investigation and to develop solutions requiring significant original thinking.
• Ability to determine appropriate courses of action in complex situations that may not be addressed by existing policies or protocols.
• Ability to maintain complete and accurate enrollee records.
• Effective verbal and written communication skills.
• Ability to work well with clinicians, hospital officials, and service-agency contacts.
• GED or high school education required.
• Valid in-state driver license required.

Nice To Haves

• Associate degree or bachelor’s degree.
• Certified Case Manager (CCM) certification.
• Licensed Clinical Social Worker (LCSW) license.
• Registered Nurse (RN) license in a state or compact state.

Responsibilities

• Coordinate care through assessment, care planning, implementation, coordination, monitoring, and evaluation.
• Conduct in-depth health risk and comprehensive needs assessments across psychosocial, physical, medical, behavioral, environmental, and financial factors.
• Develop, document, communicate, and implement care plans that address members’ needs and connect them with appropriate resources.
• Serve as a point of contact to help ensure services are delivered appropriately, including during transitions to home care and coordination of backup plans and community-based services.
• Implement, coordinate, and monitor strategies intended to improve members’ health and quality of life.
• Advocate for members by identifying and addressing gaps in care.
• Monitor and review care plans regularly, measure intervention effectiveness, and identify trends and opportunities to improve outcomes.
• Collect clinical path variance data that may indicate areas for improvement in cases and services.
• Work with members, families, and interdisciplinary care-plan teams to adjust plans when necessary.
• Educate providers, supporting staff, members, and families about the care-coordination role and health strategies.
• Facilitate team-based, cost-effective delivery of quality care and services across the continuum.
• Collaborate with members, caregivers, legal representatives, physicians, care providers, and ancillary support services to address care issues and member needs.
• Use licensed care-coordination staff as appropriate for complex cases.
• Assist members with questions and concerns regarding care, providers, or the delivery system.
• Maintain professional relationships with inpatient, outpatient, and community-resource stakeholders.
• Maintain complete and accurate enrollee records and generate reports in accordance with care-coordination goals.
• Assist with orientation and mentoring of new team members as appropriate.

Benefits

• Short-term incentives may be available.
• Comprehensive benefits package.
• Health, life, voluntary, and other benefits and perks supporting physical, mental, emotional, and financial wellbeing.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED