CISC Care Coordinator - Rio Rancho, NM

Military Spouse Corporate Career Network • Rio Rancho, NM

2d • Remote

About The Position

The CISC Care Coordinator coordinates care for identified client 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 quality of care 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; candidates must live in Rio Rancho, New Mexico, or the surrounding area.

The coordinator provides care coordination for members with behavioral health conditions who require intensive interventions and oversight involving clinical, social, and community resources. The position conducts in-depth health risk or comprehensive needs assessments; develops and implements care plans; advocates for members; monitors outcomes and identifies gaps in care; and works with members, families, providers, and interdisciplinary teams to coordinate appropriate services. The coordinator may assist with orientation and mentoring of new team members and generate reports aligned with care coordination goals. Duties listed are representative and may include additional or other duties aligned 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 and why, with the ability to interpret data.
• Ability to make decisions requiring significant analysis and investigation and 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.
• Valid in-state driver's license.
• High school education or GED required.
• Must live in Rio Rancho, NM, or surrounding area.

Nice To Haves

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

Responsibilities

• Coordinate care through assessment, care planning, implementation, coordination, monitoring, and evaluation.
• Promote appropriate use of clinical and financial resources to improve care quality and member satisfaction.
• Assist with orientation and mentoring of new team members as appropriate.
• Provide care coordination to members with behavioral health conditions requiring intensive interventions and oversight.
• Conduct in-depth health risk and comprehensive needs assessments, including psychosocial, physical, medical, behavioral, environmental, and financial considerations.
• Communicate and develop care plans and serve as a point of contact to ensure services are appropriately rendered, 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 that address social, physical, mental, emotional, spiritual, and supportive needs.
• Advocate for members by identifying and addressing gaps in care.
• Monitor plans of care and measure intervention effectiveness against care plan goals.
• Review care plans regularly to identify care gaps and trends that may improve health and quality-of-life outcomes.
• Collect clinical path variance data to identify potential opportunities to improve cases and services.
• Work with members and the interdisciplinary care plan team to adjust plans of care when necessary.
• Educate providers, supporting staff, members, and families about care coordination and health strategies using a member-focused approach.
• Facilitate a team approach to coordinated, 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 medical, behavioral, social, community-based, or long-term care 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 external stakeholders, including inpatient, outpatient, and community resources.
• Generate reports in accordance with care coordination goals.
• Perform additional duties assigned by a leader that align with the intent of the job.

Benefits

• Comprehensive benefits package.
• Health, life, voluntary, and other benefits and perks supporting physical, mental, emotional, and financial wellbeing.
• May be eligible for short-term incentives.

What This Job Offers

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