CISC Care Coordinator

Magellan Health • Albuquerque, NM

5d • $50,225 - $75,335

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. Duties are performed virtually or face-to-face based on contractual requirements. The role 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 care coordination to members with behavioral health conditions who require intensive interventions and oversight involving clinical, social, and community resources. The role develops and monitors member-focused plans of care, advocates for members, identifies gaps in care, measures intervention effectiveness, and collaborates with members, families, providers, and interdisciplinary teams. The coordinator also educates stakeholders, supports access to appropriate services, maintains professional relationships with external resources, and generates reports aligned with care coordination goals.

The listed duties are representative and not all-inclusive. Additional or other duties aligned with the intent of the job may be assigned.

Requirements

• Three to five 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 or 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 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.
• Valid in-state driver's license.

Nice To Haves

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

Responsibilities

• Conduct in-depth health risk assessments and comprehensive needs assessments covering psychosocial, physical, medical, behavioral, environmental, and financial factors.
• 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-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' care needs by identifying and addressing gaps in care.
• Monitor plans of care, evaluate their effectiveness, and measure the effectiveness of interventions identified in the care plan.
• Review plans of care regularly to identify gaps and trends and work with members and the interdisciplinary care plan team to adjust plans as necessary.
• Collect clinical path variance data to identify potential areas for improvement in cases and services provided.
• Educate providers, supporting staff, members, and families about care coordination and health strategies, using a member-focused approach.
• Facilitate a team approach to coordinating and delivering cost-effective, quality care and services across the continuum, including through the Interdisciplinary Care Plan team.
• 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.
• 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.

Benefits

• Potential eligibility for short-term incentives.
• Comprehensive benefits package, including health, life, voluntary, and other benefits and perks intended to support physical, mental, emotional, and financial wellbeing.

What This Job Offers

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