Case Management Coordinator

Solis Health Plans, Inc.; Florida; On-site; USD 40,000 - 52,000; Full time

Job summary

Solis Health Plans, Inc. is seeking a Case Management Care Coordinator to bridge the case management department with members and providers.

You will support care plans, reach out to members, schedule interventions, and ensure follow-up for optimal care in a fast-paced environment. The role requires bilingual Creole and English, a minimum two years in healthcare customer service, and the ability to work onsite Monday through Friday in Florida.

Qualifications

• High School Diploma or equivalent plus healthcare customer service experience.
• Experience with Medicare and managed care is preferred.
• Knowledge of CMS guidelines is preferred.
• Proficient in Microsoft Office applications.
• Excellent listening, interpersonal, verbal and written communication skills; Creole and English fluency required.

Responsibilities

• Performs member screenings and health risk assessments.
• Schedules and coordinates appointments to support care plans.
• Communicates professionally with nurses and physicians, internal and external.
• Handles inbound calls and responds to member inquiries.
• Maintains patient confidentiality and HIPAA compliance.
• Documents information accurately in the member's electronic record.
• Assists with data collection and supports care management team.

Skills

Healthcare customer service

Medicare knowledge

CMS guidelines

MS Office

Verbal and written communication

Bilingual Creole and English

Education

High School Diploma

Tools

Microsoft Office

Job description

About Us

Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued.

• Bilingual in English/ Spanish is Required **

Position is fully onsite Monday-Friday.

Position Summary

Case Management Care Coordinators play a crucial role in helping members manage their health by acting as a liaison between the health plan’s Case Management Department and the member’s healthcare providers. They perform their duties as an extension of the case management team, ensuring that the components identified as part of the member’s care are addressed and arranged. The Care Coordinators provide support by reaching out to members and ensuring their needs are met. Additionally, the Care Coordinator gathers key information that enables other members of the department, as well as those in other departments, to deliver exceptional customer care through attention to detail, empathetic communication, and necessary follow-up for optimal healthcare experiences. This role requires flexibility, quick thinking, and a caring disposition.

Essential Duties And Responsibilities

• Performs member screenings through the completion of health risk assessments.
• Completes interventions based on the member’s individualized care plan.
• Schedules appointments to support care plan goals.
• Communicates professionally with nurses and physicians, both internal and external to the organization.
• Handles inbound calls and answers member inquiries.
• Connects with members via phone and other communication methods.
• Coordinates with community resources to support interventions outlined in the member’s individualized care plan.
• Documents information accurately within the member’s electronic record.
• Assists the case management team with supporting and following up on interventions and actions.
• Ensures compliance with all regulatory requirements, including HIPAA, OSHA, and other federal, state, and local regulations.
• Assists with data collection.
• Maintains a polite and professional demeanor at all times.
• Upholds patient confidentiality at all times.
• Works effectively in a high-paced and demanding environment.
• Demonstrates the ability to multi-task and prioritize effectively.
• Assists with the training of new staff members.
• Performs other duties and projects as assigned.

Qualifications & Education

• High School Diploma and a minimum of two (2) years of experience in a healthcare-related customer service position, or an equivalent combination of education and experience.
• Experience in Medicare and managed care insurance is preferred.
• Knowledge of CMS guidelines is preferred.
• Excellent computer skills are required, including proficiency in Microsoft Office.
• Strong decision-making and organizational skills.
• Excellent listening, interpersonal, verbal, and written communication skills with individuals at all levels of the organization.
• Must be able to perform duties with minimal supervision.
• Willingness and ability to function independently as well as part of a team.
• Working knowledge of medical terminology.
• Fluency in both Creole and English is required.

Performance Measurements

• Duties accomplished at the end of the day/month.
• Attendance/punctuality.
• Compliance with Company regulations.
• Safety and Security.
• Quality of work.

What Set Us Apart

Join Solis Health Plans as a Case Management Care Coordinator and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!