Title: Case Management Coordinator - Remote
Mandatory skills:
Microsoft Office, Excel,
Case management,
Long term care,
member benefits, healthcare, member engagement, member health,
Medicaid Long Term Care, Comprehensive Program,
care coordination, care plan, care issues,
care management tools, care management resources,
information review, data review, healthcare outcomes, medical,
Monitoring, Evaluation, Documentation of Care,
quality management, healthcare decision making,
Prior Authorization, PCP, Condition management information, Medication review, Community resource
Description:
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. Our organization promotes autonomy through a Monday-Friday working schedule 8am-5pm and flexibility as you coordinate the care of your members. Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and medically complex members. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Case Management Coordinators will determine appropriate services and supports due to member’s health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.
Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.
Duties
Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
Conducts comprehensive evaluation of Members using care management tools and information/data review
Coordinates and implements assigned care plan activities and monitors care plan progress
Conducts multidisciplinary review to achieve optimal outcomes
Identifies and escalates quality of care issues through established channels
Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
Helps member actively and knowledgeably participate with their provider in healthcare decision-making
Monitoring, Evaluation and Documentation of Care:
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Experience
One year Case management experience A MUST / Case Management Certificate ( Preferred)
Long term care experience (Preferred)
Microsoft Office including Excel competent
Bilingual - Spanish / English (preferred)
Preferred Qualifications:
Bilingual Spanish/English (preferred)
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written
Education
Bachelor''s degree required - No nurses. Social work degree or related field preferred
Notes:
Monday-Friday 8am-5pm
Fully remote (never coming onsite)
safety sensitive
Training will be conducted remotely via Microsoft Teams.
Candidate will travel approximately 75% of the time within the region seeing
Members at home, in assisted living facilities and nursing homes.
VIVA USA is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.
Contact Details :
Account co-ordinator: Keerthana Bathrappan
VIVA USA INC.
3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008
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