Care Coordinator, Licensed

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

📋 Description

• Independently manages the care of individual clients, focusing on identified populations through assessment, care planning, implementation, coordination, monitoring, and evaluation to achieve cost-effective and high-quality outcomes.

• Responsibilities may involve face-to-face home visits or facility-based interactions, depending on the assignment.

• Encourages the optimal use of clinical and financial resources to enhance the quality of care and member satisfaction.

• Supports the orientation and mentoring of new team members as needed.

• May serve as a team leader for non-licensed care coordinators.

• Delivers care coordination for members with behavioral health issues identified as needing intensive interventions and oversight, utilizing multiple clinical, social, and community resources.

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

• Communicates and formulates the care plan while acting as the primary contact to ensure services are appropriately delivered (e.g., during transitions to home care, backup plans, community-based services).

• Implements, coordinates, and monitors strategies to enhance health and quality of life outcomes for members and their families.

• Develops, documents, and executes plans that provide suitable resources to address social, physical, mental, emotional, spiritual, and supportive needs.

• Advocates for members' care requirements by identifying and resolving gaps in care.

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

• Evaluates the impact of interventions as outlined in the member's care plan.

• Regularly reviews the care plan to detect gaps in care and trends that can enhance health and quality of life outcomes.

• Gathers clinical path variance data to identify potential areas for improvement in case management and services provided.

• Collaborates with members and the interdisciplinary care plan team to modify 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.

• Facilitates a collaborative team approach to ensure the cost-effective delivery of high-quality care and services.

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

⛳️ Requirements

• An Associate's Degree in Nursing is required for RNs, or a Master's Degree in Social Work or a healthcare-related field, with an independent license, for Social Workers.

• Must be licensed in the state where services are provided and meet Magellan Credentialing criteria.

• A minimum of 2 years of post-licensure clinical experience is required.

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

• Familiarity with analyzing trends from decision support systems is required.

• Business management skills, including cost/benefit analysis, negotiation, and cost containment, are necessary.

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

• Requires a detailed understanding of cost-effective care coordination, including the interpretation of data regarding what, how, and why tasks are performed.

• Ability to make decisions that involve significant analysis and investigation, often requiring innovative solutions.

• Capacity to identify appropriate courses of action in complex situations that may not be covered by existing policies or protocols.

• Strong ability to establish effective working relationships with clinicians, hospital officials, and service agency contacts is important.

• Computer literacy is preferred.

• Ability to maintain complete and accurate records for enrollees is required.

• Excellent verbal and written communication skills are essential.

🏝️ Benefits

• Magellan provides a comprehensive range of health, life, voluntary, and additional benefits and perks that support your physical, mental, emotional, and financial wellbeing.