CISC Care Coordinator (Albuquerque, NM)

Magellan Health • Albuquerque, NM

7d • Remote

About The Position

The CISC Care Coordinator coordinates care for individual clients and identified populations through assessment, care planning, implementation, coordination, monitoring, and evaluation to support cost-effective, quality outcomes. The role promotes appropriate use of clinical and financial resources to improve care quality and member satisfaction. Duties are performed virtually or face-to-face according to contractual requirements. This is a work-from-home position involving extensive travel in the community; the candidate must live in Albuquerque, New Mexico, or the surrounding area.

The coordinator provides care coordination to members with behavioral health conditions who require intensive interventions and oversight involving clinical, social, and community resources. The role conducts in-depth health risk or comprehensive needs assessments covering psychosocial, physical, medical, behavioral, environmental, and financial needs. The coordinator develops, communicates, documents, and implements care plans, serves as a point of contact to ensure services are appropriately delivered, and advocates for members by identifying and addressing gaps in care.

The position monitors care plans and interventions, evaluates outcomes, reviews plans for gaps and trends, collects clinical path variance data, and works with members and interdisciplinary teams to adjust care as needed. The coordinator educates providers, staff, members, and families about care coordination and health strategies; facilitates a team approach to quality and cost-effective care; collaborates with caregivers, legal representatives, physicians, care providers, and support services; and maintains professional relationships with external stakeholders. The role also assists members with care-related questions and concerns, generates reports, maintains accurate enrollee records, and may assist with orientation and mentoring of new team members. Listed duties are representative and not all-inclusive; leaders may assign other duties consistent with the role.

Requirements

• 3–5 years of experience in social work, nursing, or 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 based on 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 what work is done, how and why it is done, and interpretation of data.
• Ability to make decisions requiring significant analysis and investigation and to develop solutions involving significant original thinking.
• Ability to determine appropriate courses of action in complex situations that may not be covered 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.
• Candidate must live in Albuquerque, New Mexico, or the surrounding area.

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 and/or compact state.

Responsibilities

• Coordinate care through assessment, care planning, implementation, coordination, monitoring, and evaluation for cost-effective, quality outcomes.
• Promote appropriate use of clinical and financial resources to improve care quality and member satisfaction.
• Provide intensive care coordination for members with behavioral health conditions and needs involving clinical, social, and community resources.
• Conduct in-depth health risk and comprehensive needs assessments, including psychosocial, physical, medical, behavioral, environmental, and financial parameters.
• Communicate, develop, document, and implement care plans and serve as a point of contact to ensure services are appropriately rendered.
• Implement, coordinate, and monitor strategies for members and families to improve health and quality-of-life outcomes.
• Identify and address gaps in care and advocate for members' care needs.
• Monitor plans of care and evaluate the effectiveness of interventions; regularly review plans for gaps and trends.
• Collect clinical path variance data indicating potential areas for improvement in cases and services.
• Work with members and interdisciplinary care plan teams to adjust plans of care as necessary.
• Educate providers, supporting staff, members, and families about care coordination and health strategies, emphasizing member-focused care.
• Facilitate a team approach to coordination and 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.
• Utilize 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 external stakeholders, including inpatient, outpatient, and community resources.
• Generate reports in accordance with care coordination goals.
• Maintain complete and accurate enrollee records.
• Assist with orientation and mentoring of new team members as appropriate.
• Perform duties virtually or face-to-face according to contractual requirements and travel extensively in the community.

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
• Education Level: High school or GED