Population Health & Care Coordination Aide

South Florida Community Care Network•Sunrise, FL

12d•Hybrid

About The Position

The Care Coordinator Aide (CCA), also referred to as a Healthcare Navigator, supports the Care Coordination team within a health insurance plan. The role assists with coordinating care, navigating healthcare services, and helping enrollees understand and access their health benefits. It facilitates communication among enrollees, providers, and care teams to support timely, appropriate care and comprehensive member advocacy. The CCA supports Care Coordinators with administrative tasks, service coordination, outreach, follow-up, documentation, and other activities that help enrollees navigate the healthcare system. The position requires a strong commitment to customer service, knowledge of Medicaid benefits and healthcare access, and a proactive, flexible approach to supporting care coordination initiatives. The role follows a hybrid work schedule, which the company may change based on business needs. Work may take place inside or outside the office and may involve travel to other offices and domestic travel. The noise level is usually moderate. Candidates selected for the position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse, in compliance with Florida law.

Requirements

Minimum of an Associate Degree in Nursing or Social Work.
At least 2 years of experience assisting a team that manages chronic diseases, complex medical cases, social needs, or care coordination, preferably in a hospital, outpatient clinic, or community health organization.
At least 2 years of experience in a managed care, health plan, or insurance setting in a role related to chronic disease management, case management, social work, or care coordination.
Demonstrated experience assisting members with complex medical and social needs, helping them navigate the healthcare system, and collaborating with multidisciplinary teams to close gaps in care and improve health outcomes.
Familiarity with Medicaid, Medicare, or other state and federal healthcare programs, including relevant regulations, compliance standards, and quality benchmarks.
Proficiency in Microsoft Office Suite and other relevant software for documentation and data management.
Ability to self-motivate, work independently, and manage time and resources effectively with minimal supervision.
Strong oral and written communication skills, including the ability to explain complex information to diverse audiences and collaborate with multidisciplinary teams.
Strong organizational, problem-solving, interpersonal, and human relations skills, including the ability to manage multiple priorities in a dynamic healthcare environment.
Ability to participate in cross-functional teams and follow projects or assignments through to successful completion.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals; write routine reports and correspondence; and present information effectively.
Competence in basic arithmetic, rates, ratios, percentages, and interpreting bar graphs.
Ability to solve practical problems in situations with limited standardization and interpret written, oral, diagram, or schedule-based instructions.
Ability to meet the state-specific licensure requirements for social workers, if applicable to the candidate's qualifications.
Selected candidates must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

Nice To Haves

Certifications in healthcare navigation or case management.
Licensed Practical Nurse (LPN) or Registered Nurse (RN) license.
Healthcare Navigator Certification.
Certified Case Manager (CCM).
Chronic Care Professional (CCP) Certification.
Certified Professional in Healthcare Quality (CPHQ).
Disease Management Certification (CDMS).
Patient Navigator Certification (PNC).
Registered Medical Assistant (RMA) qualification.
Experience with electronic health record systems such as EPIC, JIVA, or similar platforms.
Experience with motivational interviewing techniques and understanding of adult learning styles.

Responsibilities

Assist Care Coordinators in managing enrollee care plans and healthcare services, coordinating with providers and other stakeholders, and following up to ensure care needs are met.
Conduct outreach to new enrollees, explain benefits and care options, and complete initial assessments to identify care needs and support onboarding.
Follow up with enrollees after discharge and track PASRR assessments, other required evaluations, and Health Risk Assessment statuses.
Assist with updating and maintaining accurate medication lists for facility residents.
Support managed care plan procedures and activities related to the Florida Medicaid Management Information System (FLMMIS).
Help enrollees understand and access covered benefits and services.
Maintain accurate electronic enrollee case files in compliance with departmental and regulatory requirements, gather signature forms, and complete care coordination documentation.
Connect enrollees with relevant community resources and support the Provider Network, including service coordination agreement (SCA) support.
Assist with disaster outreach, including hurricane preparedness, and help ensure enrollees have resources and support during emergencies.
Facilitate mailings and conduct documented outreach to enrollees who are difficult to contact.
Support the Grievance and Appeals team by helping enrollees navigate complaints, grievances, and appeals.
Manage the department worklist, SharePoint site, and calendar activities; assist with case closure and ensure required tasks are completed before finalization.
Participate in ongoing learning about Medicaid changes, policies, and procedures; assist with training new staff and department training sessions.
Monitor and order staff supplies, assist with special projects such as coordination of expanded benefits, and adapt to changing department needs.
Perform other job-related duties assigned by management and leadership.