CISC Care Coordinator

Magellan Health • Las Vegas, NV

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. 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 orienting and mentoring new team members.

Provides care coordination for members with behavioral health conditions requiring intensive interventions and oversight across clinical, social, and community resources. Conducts in-depth health risk and comprehensive needs assessments, develops and communicates care plans, coordinates services, monitors outcomes, identifies gaps in care, and advocates for members. Collaborates with members, families, caregivers, legal representatives, physicians, providers, and ancillary services through an interdisciplinary care plan team. Educates providers, staff, members, and families about care coordination and health strategies; maintains relationships with external stakeholders; and generates reports in accordance with care coordination goals.

The duties listed are representative and not all-inclusive. A leader may assign additional or other duties aligned with the intent of the job.

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 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, with 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.
• Required education: GED or high school education.
• Required license: valid in-state driver license.

Nice To Haves

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

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 intensive care coordination for members with behavioral health conditions and complex clinical, social, and community resource needs.
• Conduct in-depth health risk and comprehensive needs assessments covering psychosocial, physical, medical, behavioral, environmental, and financial parameters.
• Communicate and develop care plans, and serve as a point of contact to ensure services are appropriately delivered, including during transitions to home care and coordination of backup plans and community 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 review plans regularly to identify gaps and trends.
• Collect clinical path variance data to identify potential improvement areas 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 using a member-focused approach.
• Facilitate team-based, cost-effective delivery of quality care and services across the continuum.
• Collaborate with interdisciplinary teams that may include members, caregivers, legal representatives, physicians, care providers, and ancillary support services.
• 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.
• Maintain complete and accurate enrollee records.

Benefits

• The position may be eligible for short-term incentives.
• Comprehensive benefits package, including 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