CISC Care Coordinator

Magellan Health • Las Vegas, NM

5d • $50,225 - $75,335

About The Position

Coordinates care for individual clients and identified populations through assessment, care planning, implementation, coordination, monitoring, and evaluation to support cost-effective, high-quality outcomes. Work is performed virtually or face-to-face according to contractual requirements. 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.

The Care Coordinator supports members with behavioral health conditions who need intensive interventions and oversight involving clinical, social, and community resources. The role assesses member needs, develops and monitors care plans, coordinates services, advocates for members, collaborates with interdisciplinary teams and external stakeholders, educates members and providers, and generates reports related to care coordination goals. Duties listed are representative rather than all-inclusive, and additional duties aligned with the role may be assigned.

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 and how work is done and why, with the ability to interpret data.
• Ability to make decisions requiring significant analysis and investigation and develop solutions involving 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 and ability to work well with clinicians, hospital officials, and service agency contacts.
• High school diploma or GED required.
• Valid in-state driver's license required.

Nice To Haves

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

Responsibilities

• Provide care coordination to members with behavioral health conditions requiring intensive interventions and oversight.
• Conduct in-depth health risk and comprehensive needs assessments covering psychosocial, physical, medical, behavioral, environmental, and financial factors.
• Communicate and develop the care plan, serving as a point of contact to ensure services are appropriately delivered, 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 provide resources for social, physical, mental, emotional, spiritual, and supportive needs.
• Advocate for members by identifying and addressing gaps in care.
• Monitor plans of care on an ongoing basis and evaluate the effectiveness of interventions.
• Assess and review plans of care regularly to identify gaps and trends and improve health and quality-of-life outcomes.
• Collect clinical path variance data that may indicate areas for improvement in cases and services.
• Work with members and interdisciplinary care plan teams to adjust plans of care when necessary.
• Educate providers, supporting staff, members, and families about care coordination and health strategies, with a member-focused approach.
• Facilitate a team approach to coordinated, cost-effective delivery of quality care and services across the continuum.
• Collaborate with interdisciplinary care plan teams, which may include members, caregivers, legal representatives, physicians, care providers, and ancillary support services, to address care issues, member needs, 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.
• Assist with orientation and mentoring of new team members as appropriate.

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