Population Health & Care Coordination Aide

5819e54c-5980-4670-adef-3258d4b05f16•Sunrise, FL

15h•$20 - $25•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 their health benefits. It focuses on seamless coordination, comprehensive care, and member advocacy, facilitating communication among enrollees, providers, and care teams so members receive timely and appropriate care. The CCA supports Care Coordinators with administrative tasks and service coordination, and helps ensure enrollees have the resources and guidance needed to navigate the healthcare system. The position requires customer service skills, knowledge of Medicaid benefits and healthcare access, and a proactive approach to care coordination. Community Care Plan currently follows a hybrid work schedule and reserves the right to change schedules based on company needs. The 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. The employer is committed to equal opportunity and fostering diversity, equity, and inclusion. Candidates selected for the position must complete a Level 2 background screening through Florida’s Care Provider Background Screening Clearinghouse.

Requirements

Minimum of an Associate Degree in Nursing or Social Work.
At least 2 years of experience assisting a team managing chronic diseases, complex medical cases, social needs, or care coordination; experience in hospitals, outpatient clinics, or community health organizations is preferred.
At least 2 years of experience in a managed care, health plan, or insurance environment 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 in navigating healthcare 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 with Microsoft Office Suite and other relevant documentation and data-management software.
Ability to self-motivate, work independently, and manage time and resources effectively with minimal supervision.
Exceptional oral and written communication skills and the ability to convey complex information clearly to patients, providers, and team members.
Strong interpersonal communication and relationship-building skills for collaboration within multidisciplinary teams.
Strong organizational, problem-solving, and prioritization skills in a dynamic healthcare environment.
Ability to interact professionally and navigate complex patient and provider interactions.
Ability to build and participate in cross-functional teams.
Ability to follow projects and assignments through to completion, exercise decisive judgment, and pursue quality outcomes.
Experience with motivational interviewing techniques and understanding of adult learning styles to engage and educate members in self-management.
Strong analytical skills, including the ability to read and interpret documents, safety rules, instructions, and procedure manuals.
Ability to write routine reports and correspondence and present information effectively to groups of customers or employees.
Basic mathematical skills, including arithmetic, rates, ratios, percentages, and interpretation of bar graphs.
Ability to solve practical problems in situations with limited standardization and interpret written, oral, diagrammatic, or schedule-based instructions.
Ability to meet the role’s physical demands, including extended periods of sitting, use of hands, reaching, standing, walking, occasional stooping, kneeling, crouching, or crawling, and occasional lifting or moving of items up to 15 pounds.
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.
State licensure meeting applicable state-specific requirements for social workers.
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).
Medical Assistance (RMA).
Experience with electronic health record systems such as EPIC, JIVA, or similar platforms.

Responsibilities

Assist Care Coordinators in managing enrollee care plans and healthcare services.
Coordinate with providers and other stakeholders to support timely, appropriate care.
Facilitate care planning and conduct regular follow-up to ensure enrollee care needs are met.
Contact new enrollees to explain benefits and care options, complete initial assessments, and support onboarding.
Conduct post-discharge follow-ups to check that enrollees are receiving appropriate care.
Track and monitor PASRR assessments and other required enrollee evaluations.
Follow up on Health Risk Assessment (HRA) statuses to support care coordination.
Assist with updating and maintaining accurate, complete 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.
Assist with gathering signature forms and completing care coordination documentation.
Connect enrollees with relevant community resources and support the Provider Network, including SCA (service coordination agreement) support.
Assist with disaster outreach, including hurricane preparedness.
Facilitate timely mailing and distribution of enrollee information and resources.
Conduct and document outreach attempts to enrollees who are difficult to contact, and follow through on those attempts.
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 tasks are complete before cases are finalized.
Participate in ongoing learning and remain current on Medicaid changes, policies, and procedures.
Assist in training new staff and contribute to department training sessions.
Monitor and order staff supplies as needed.
Assist with special projects, including coordination of expanded benefits.
Adapt to changing department needs and provide flexible support across care coordination tasks.
Perform other job-related duties assigned by management and leadership.