Bilingual Case Management Coordinator

VIVA USA Inc; Tallahassee (FL); Presencial; USD 46.000 - 62.000; Jornada completa

Descripción de la vacante

VIVA USA Inc is seeking a self-motivated, bilingual (Spanish-English) Case Management Coordinator to join our Case Management team in Florida. The role involves telephonic and face-to-face assessments, care plan development, and coordinating services to improve health outcomes for Medicaid Long Term Care/Comprehensive Program enrollees.

You will manage a caseload, obtain prior authorizations, work with PCPs and specialists, provide education and support, and connect members with community

Formación

• One year of case management experience required.
• Bachelor's degree required; nursing not required. Social work or related field preferred.
• Bilingual Spanish/English is required.

Responsabilidades

• Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
• Conducts telephonic and face-to-face assessments and develops care plans.
• Manages a caseload and coordinates services to improve health outcomes.
• Obtains prior authorizations and coordinates with PCPs and specialists.
• Provides care coordination education and support, including medication reviews.
• Connects members to community resources and support services.
• Documents care management processes in compliance with guidelines.

Conocimientos

Bilingual Spanish-English

Educación

Bachelor's degree

Case Management Certificate

Herramientas

Microsoft Office

Excel

Outlook

Descripción del empleo

Candidate will travel approximately 75% of the time within the region seeing

We are seeking a self-motivated, energetic, detail-oriented, highly organized, and tech-savvy Bilingual (Spanish-English) Case Management Coordinator to join our Case Management team.

The Case Management Coordinator is responsible for conducting telephonic and/or face-to-face assessments, developing and implementing care plans, managing a caseload of supportive and medically complex members, and coordinating services to improve health outcomes and overall wellness. Responsibilities include obtaining prior authorizations, coordinating care with PCPs and specialty providers, providing condition management education, conducting medication reviews, and connecting members to community resources and support services. The ideal candidate possesses strong communication, organizational, and problem-solving skills and is committed to delivering high-quality, member-centered care.

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, Outlook- competent
• Bilingual - Spanish / English (required)

Preferred Qualifications

• 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.

Training

Training will be conducted remotely via Microsoft Teams.

Notes

• Monday-Friday 8am-5pm.
• safety sensitive

Candidate will travel approximately 75% of the time within the region seeing Members at home, in assisted living facilities and nursing homes.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status