CISC Care Coordinator - Las Cruces

Magellan Health • Las Cruces, NM

3d • Remote

About The Position

The CISC Care Coordinator coordinates care for individual clients in identified populations through assessment, care planning, implementation, coordination, monitoring, and evaluation to promote cost-effective, high-quality outcomes. The position is work from home with extensive travel in the community; candidates must reside in Las Cruces, New Mexico, or the surrounding area. Duties are performed virtually or face-to-face according to contractual requirements. The coordinator promotes appropriate use of clinical and financial resources to improve quality of care and member satisfaction, and may assist with orientation and mentoring of new team members.

The coordinator provides intensive care coordination and oversight for members with behavioral health conditions who may need multiple clinical, social, and community resources. Responsibilities include conducting in-depth health risk or comprehensive needs assessments; developing and communicating care plans; serving as a point of contact to ensure appropriate services; implementing and monitoring strategies to improve health and quality of life; advocating for members and addressing gaps in care; and evaluating intervention effectiveness. The coordinator collaborates with members, families, caregivers, legal representatives, physicians, care providers, ancillary services, and interdisciplinary care plan teams to address medical, behavioral, social, community-based, and long-term care needs. The role also includes educating stakeholders, maintaining professional relationships with external resources, assisting members with questions and concerns, collecting clinical path variance data, and generating reports in accordance with care coordination goals.

The listed duties are representative and not all-inclusive; additional duties aligned with the intent of the job may be assigned. The position requires compliance with applicable security responsibilities, legal and regulatory requirements, contractual requirements, and internal policies and procedures.

Requirements

• 3–5 years of experience in social work, nursing, a healthcare-related field, or relevant experience in lieu of a degree.
• 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 interpretation of data.
• Ability to make decisions requiring significant analysis and investigation, with solutions requiring original thinking.
• Ability to determine appropriate courses of action in complex situations not 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.
• Valid in-state driver's license.
• Candidates must reside in Las Cruces, New Mexico, or the surrounding area.

Nice To Haves

• Associate degree or bachelor's degree preferred.
• Certified Case Manager (CCM) certification preferred.
• Licensed Clinical Social Worker (LCSW) credential preferred.
• Registered Nurse (RN) state and/or compact state licensure preferred.

Responsibilities

• Coordinate care through assessment, care planning, implementation, coordination, monitoring, and evaluation to support cost-effective, quality outcomes.
• Promote appropriate use of clinical and financial resources to improve care quality and member satisfaction.
• Provide care coordination and oversight for members with behavioral health conditions requiring intensive interventions and multiple clinical, social, and community resources.
• Conduct in-depth health risk assessments and comprehensive needs assessments covering psychosocial, physical, medical, behavioral, environmental, and financial needs.
• Develop and communicate care plans and serve as a point of contact to ensure services are appropriately provided, including during transitions to home care and coordination of backup plans and community-based services.
• Implement, coordinate, and monitor strategies for members and families to improve health and quality of life outcomes.
• Develop, document, and implement plans addressing social, physical, mental, emotional, spiritual, and supportive needs.
• Advocate for members by identifying and addressing gaps in care.
• Monitor plans of care, measure intervention effectiveness, and regularly review plans to identify care gaps and trends.
• Collect clinical path variance data indicating potential areas for improvement in cases and services provided.
• Work with members and interdisciplinary care plan teams to adjust plans of care when necessary.
• Educate providers, support staff, members, and families about care coordination and health strategies using a member-focused approach.
• Facilitate coordinated, cost-effective delivery of quality care and services, including through the Interdisciplinary Care Plan team and across the continuum of care.
• Collaborate with members, caregivers, legal representatives, physicians, care providers, and ancillary support services to address care issues and member needs.
• Utilize licensed care coordination staff as appropriate for complex cases.
• Assist members with questions and concerns about care, providers, or the delivery system.
• Maintain professional relationships with external stakeholders, including inpatient, outpatient, and community resources.
• Generate reports in accordance with care coordination goals.
• Assist with orientation and mentoring of new team members as appropriate.
• Comply with position-specific security responsibilities and applicable legal, regulatory, contractual, and internal requirements.

Benefits

• The position may be eligible for short-term incentives.
• 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