Clinical Coordinator - Care Manager - Medicaid

Upper Peninsula Health Plan•Marquette, MI

About The Position

The Clinical Coordinator - Care Manager Medicaid provides care management services to multiple member populations, including people with disabilities, pregnant and postpartum members, members with chronic conditions, individuals enrolled in or eligible for Children’s Special Health Care Services, children in foster care, former foster care youth in Foster Care Transitional Medicaid, members receiving Cell and Gene Therapy, and members engaged with mental or behavioral health services. The coordinator is a member’s single point of contact and conducts assessments of health history, home environment, community-service access, and behavioral and health-related social needs. Based on these assessments, the coordinator develops and maintains person-centered care plans and coordinates medical, behavioral health, and community-based services. The role includes face-to-face visits in a range of care settings and locations chosen by members, advocacy and collaboration with providers and support teams, identification of barriers to care, and monitoring of service delivery and referrals. The coordinator also addresses risk-management and quality concerns, follows organizational and regulatory requirements, supports process improvement, and participates in team and program meetings. The position works in office conditions with frequent localized travel for member visits and may involve interruptions and occasional irregular hours.

Requirements

Licensed registered nurse; Michigan licensure is required.
At least two years of clinical or health-related experience as a licensed registered nurse or social worker.
Valid driver’s license and proof of insurance.
Working vehicle.
Keyboarding proficiency and working knowledge of Microsoft Word and Excel.
Excellent interpersonal and oral and written communication skills.
Strong organizational and prioritization abilities.

Nice To Haves

Bachelor of Science in Nursing, limited licensed bachelor’s or master’s degree in social work, or fully licensed bachelor’s or master’s degree in social work.
Two years of clinical managed-care experience or five years of clinical experience as a licensed registered nurse or social worker.
Experience in care management.
Experience reviewing statistical data.
Ability to interpret and analyze data.
Working knowledge of Microsoft Access and PowerPoint.

Responsibilities

Follow UPHP policies and procedures, objectives, safety standards, and confidentiality requirements.
Conduct face-to-face member visits in healthcare facilities, community settings, and other locations where members live, learn, work, play, or worship.
Provide care management services to multiple member populations, including disabled populations, pregnant and postpartum members, members with chronic conditions, CSHCS participants or eligible members, children in foster care, former foster care youth in Foster Care Transitional Medicaid, members within Cell and Gene Therapy, and members engaged with mental or behavioral health services.
Serve as a member’s single point of contact and assess health history, home environment, access to community-based services, and behavioral and health-related social needs.
Assess members’ health status, resource use, treatment plans, prognosis, goals, and treatment and provider options.
Develop and maintain person-centered care plans with objectives, goals, and interventions tailored to member needs.
Monitor and coordinate services and referrals to community organizations, medical care, behavioral health, and other services.
Identify barriers to care and use critical thinking to address member questions and unmet physical, health-related social, and behavioral health needs.
Advocate for members and collaborate with support teams, medical offices, equipment companies, home health agencies, hospital teams, and other parties to coordinate discharge plans, care plans, and transitions between settings.
Identify and report relevant risk-management and quality concerns to the appropriate body.
Perform assigned duties in accordance with UPHP plans and procedures, NCQA standards, and regulatory requirements.
Participate in process-improvement activities and help develop and maintain care-management policies and procedures consistent with regulatory and accrediting standards.
Maintain knowledge of applicable MDHHS, CMS, DIFS, NCQA, and HEDIS standards and measures, and assume responsibility for assigned NCQA standards.
Back up other team members during periods of excessive workload or benefit time.
Attend and participate in organizational, departmental, interdisciplinary care team, and other clinical program meetings as required.
Maintain confidentiality of client data and comply with audit, documentation, charting, and timeline requirements.
Perform other related duties as assigned or requested.