Case Management Coordinator

ICONMA; Florida; On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health Benefits

Referral Program

Growth opportunities

Job summary

ICONMA supports a Miami-Dade County Retail Pharmacy client seeking a Case Management Coordinator. You will assess, plan, implement and coordinate case management activities with members to evaluate medical needs and promote overall wellness.

You will manage a diverse caseload including medically complex members, coordinate with PCPs and specialists, and use care management tools to monitor progress. Bilingual English/Spanish required.

Qualifications

• Fluent in English and Spanish, both spoken and written.
• Bachelor's degree in social work or related field required.
• Case management experience required; long term care experience preferred.
• Microsoft Office experience: Excel, Teams, Outlook.
• Ability to multitask in a fast-paced environment.
• Verifyable High School Diploma or GED.

Responsibilities

• Assess, plan, implement, and coordinate case management activities with members to evaluate medical needs.
• Manage a caseload including supportive and medically complex members.
• Develop proactive actions to enhance short and long-term outcomes and overall wellness.
• Determine services and supports: prior authorizations, PCP coordination, medicines review, and community resources.
• Coordinate case management for Medicaid Long Term Care enrollees.
• Use care management tools and data to monitor progress and inform care.
• Conduct multidisciplinary reviews to achieve optimal outcomes.
• Escalate quality of care issues per policy and procedures.
• Coach and support members to engage in informed health decisions.

Skills

Bilingual English/Spanish

Organizational skills

Multitasking

Tech-savvy

Excellent communication

Education

Bachelor's degree in social work

High School Diploma or GED

Tools

Excel

Teams

Outlook

Job description

Our client, a Retail Pharmacy company, is looking for a Case Management Coordinator for their Miami-Dade County, FL location.

Responsibilities

• 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.
• 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.

Requirements

• Must Be Fluent In English And Spanish
• We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team in Miami-Dade County, FL.
• Verifyable High School Diploma or GED Required
• Case Management experience required.
• Long Term Care experience preferred.
• Microsoft Office experience required: Excel, Teams, Outlook.
• Bilingual (Spanish, English) FLUENT speaking and writing.
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
• Effective communication skills, both verbal and written.
• Bachelor’s degree in social work or related field required. No Nurses.

Why Should You Apply?

• Health Benefits
• Referral Program

Excellent growth and advancement opportunities