Care Coordinator – CISC

This is a fully remote position, open to applicants in New Mexico.

📋 Description

• Coordinates the care of individual clients while applying it to identified populations through assessment, care planning, implementation, coordination, monitoring, and evaluation to achieve cost-effective and quality outcomes.

• Tasks are carried out either virtually or in person according to contractual obligations.

• Advocates for the judicious use of clinical and financial resources to enhance care quality and member satisfaction.

• Aids in the orientation and mentoring of new team members as appropriate.

• Provides care coordination for members with behavioral health conditions that require intensive interventions and oversight, involving multiple clinical, social, and community resources.

• Conducts comprehensive health risk assessments and/or thorough needs assessments that encompass psycho-social, physical, medical, behavioral, environmental, and financial factors.

• Communicates and formulates care plans, serving as the main point of contact to ensure the proper execution of services (e.g., during transitions to home care, backup plans, community-based services).

• Implements, coordinates, and monitors strategies aimed at enhancing health and quality of life outcomes for members and their families.

• Develops, documents, and executes a plan that provides suitable resources to meet social, physical, mental, emotional, spiritual, and supportive needs.

• Acts as an advocate for members' care needs by identifying and addressing any gaps in care.

• Conducts ongoing evaluations of the care plan to assess its effectiveness.

• Measures the success of interventions as outlined in the member's care plan.

• Regularly reviews and assesses the care plan to identify care gaps and trends for improving health and quality of life outcomes.

• Collects clinical path variance data to highlight potential areas for enhancement in case management and services provided.

• Collaborates with members and the interdisciplinary care plan team to adjust the care plan as necessary.

• Educates providers, support staff, members, and families about the care coordination role and health strategies, emphasizing a member-focused approach to care.

• Promotes a team-oriented approach to the coordination and efficient delivery of high-quality care and services.

• Collaborates with the interdisciplinary care plan team, which may include members, caregivers, legal representatives, physicians, care providers, and ancillary support services, to address care issues, specific member needs, and disease processes across medical, behavioral, social, community-based, or long-term care services.

• Utilizes licensed care coordination staff as needed for complex cases.

• Assists members with inquiries and concerns regarding care, providers, or the delivery system.

• Maintains professional relationships with external stakeholders, including inpatient, outpatient, and community resources.

• Generates reports in alignment with care coordination goals.

⛳️ Requirements

• 3-5 years of experience in Social Work, Nursing, or a Healthcare-related field, or equivalent experience in lieu of a degree.

• Experience in utilization management, quality assurance, home or facility care, community health, long-term care, or occupational health is required.

• Proficient in analyzing trends utilizing decision support systems.

• Possesses business management skills, including, but not limited to, cost/benefit analysis, negotiation, and cost containment.

• Knowledge of referral coordination to community and private/public resources is essential.

• Requires a detailed understanding of cost-effective care coordination, including the rationale behind processes and the ability to interpret data.

• Capable of making decisions that necessitate significant analysis and investigation, with solutions requiring innovative thinking.

• Ability to determine suitable courses of action in complex situations that may not be covered by existing policies or protocols.

• Must maintain complete and accurate enrollee records.

• Strong verbal and written communication skills are essential.

• Ability to collaborate effectively with clinicians, hospital officials, and service agency contacts.

🏝️ Benefits

• Short-term incentives

• Comprehensive benefits package

• A wide array of health, life, voluntary, and other benefits and perks that promote your physical, mental, emotional, and financial well-being