Care Coordinator- CISC

Magellan Health; Albuquerque (NM); Hybrid; USD 50,000 - 75,000; Full time

Benefits offered by this job

Health benefits

Life insurance

Voluntary benefits

Job summary

Magellan Health in the United States is seeking a Care Coordinator-CISC to coordinate care for individuals with complex needs, applying assessment, planning, and evaluation across virtual or in-person settings based on contractual requirements. You will work within an interdisciplinary team to optimize outcomes and ensure quality care.

Responsibilities include developing care plans, mentoring team members, and advocating for members while navigating social, medical, and community resources.

Qualifications

• 3-5 years' experience in Social Work, Nursing, or Healthcare-related field.
• Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health.
• Knowledge of referral coordination to community and private/public resources.
• Ability to make decisions requiring analysis and investigation with original thinking.

Responsibilities

• Coordinate care for individual clients with assessment, care planning and monitoring, including virtual or face-to-face in alignment with contractual requirements.
• Promote cost-effective use of clinical and financial resources to improve quality of care and member satisfaction.
• Educate providers and staff about care coordination role and health strategies; act as a care plan advocate.
• Develop and monitor care plans with interdisciplinary team to address social, physical, mental and environmental needs and assess gaps in care.

Skills

Verbal communication

Written communication

Analytical thinking

Decision making

Care coordination

Interdisciplinary collaboration

Education

GED, High School

Associate degree

Bachelor's degree

Job description

Job Duties

Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties are performed virtually or face-to-face based on contractual requirements. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters. Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (e.g., during transition to home care, backup plans, community-based services). Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for member`s care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan. Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary. Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost-effective delivery to quality care and services. Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long-term care services. Utilizes licensed care coordination staff as appropriate for complex cases. Provides assistance to members with questions and concerns regarding care, providers or delivery system. Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources. Generates reports in accordance with care coordination goal. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Other Job Requirements Responsibilities

3-5 years' experience in Social Work, Nursing, or Healthcare-related field, or relevant experience in lieu of degree., Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required. Experience in analyzing trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment. Knowledge of referral coordination to community and private/public resources. Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data. Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking. Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols. Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures. Ability to maintain complete and accurate enrollee records. Effective verbal and written communication skills. Ability to work well with clinicians, hospital officials and service agency contacts.

General Job Information

Title Care Coordinator- CISC

Grade 22

Work Experience - Required Clinical, Quality

Work Experience - Preferred

Education - Required GED, High School

Education - Preferred Associate, Bachelor's

License and Certifications - Required DL - Driver License, Valid In State

License and Certifications - Preferred CCM - Certified Case Manager - Care MgmtCare Mgmt

License and Certifications - Preferred LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt

License and Certifications - Preferred RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt

Salary Range Salary Minimum: $50,225 Salary Maximum: $75,335 This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package.

Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Magellan is the employer of choice for hard working people interested in making a difference in the healthcare industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.

Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.

Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here.