Complex Care Coordinator (Buncombe County, NC)

Vaya Health; North Carolina; Remote; USD 45,000 - 75,000; Full time

Job summary

An established industry player is seeking a Complex Care Coordinator to enhance care for Medicaid members in North Carolina. This role involves proactive coordination of care, ensuring compliance with health standards, and collaborating with various stakeholders to bridge care gaps. The ideal candidate will possess strong communication and organizational skills, alongside a solid understanding of Medicaid regulations and behavioral health. If you're passionate about making a difference in the healthcare landscape and enjoy working in a dynamic environment, this opportunity is perfect for you.

Qualifications

• Bachelor's degree in health, psychology, or related field with two years of experience.
• Licensed RN in North Carolina with four years of relevant experience qualifies.

Responsibilities

• Coordinate care for Medicaid members with complex health needs.
• Collaborate with care teams and facilitate communication among providers.
• Maintain electronic health records and ensure documentation compliance.

Skills

Communication Skills

Organizational Skills

Problem-Solving Skills

Knowledge of Medicaid Regulations

Proficiency in Microsoft Office

Education

Bachelor's Degree in Health or Related Field

RN Licensure in North Carolina

Tools

Microsoft Office

Vaya Systems

Job description

LOCATION:

Remote - must live in or near Buncombe County, North Carolina. The position must reside in North Carolina or within 40 miles of the North Carolina border.

GENERAL STATEMENT OF JOB

The Complex Care Coordinator (CCC) is responsible for knowing and implementing North Carolina Department of Health and Human Services standards and organizational policies.

CCC proactively intervenes and coordinates care for Medicaid members not eligible for Tailored Care Management with complex care needs, including members with Behavioral Health Transitional Care Needs; Special Health Care Needs related to Behavioral Health, Intellectual/Developmental Disabilities (I/DD), TBI; and those obtaining care management or case management through other entities and not engaged in TCM.

The CCC collaborates with Vaya staff, care teams, providers, community stakeholders, members, and families to address care gaps, coordinate multidisciplinary care planning, and facilitate service linkages across healthcare networks. This is a mobile position, working in various locations such as members' homes, provider offices, and remotely. Essential functions include:

1. CM Platform basics
2. Outreach & Engagement
3. Release of Information practices
4. Health Risk Assessment
5. Medication List and Continuity of Care
6. Care Planning
7. Interdisciplinary Care Team and Ongoing Care Management
8. Transitional Care Management
9. Diversion

ESSENTIAL JOB FUNCTIONS

Clinical Assessment, Care Planning & Interdisciplinary Care Team:

1. Oversee Care Transitions for eligible members, including assessments, discharge planning, and follow-up.
2. Coordinate care for members with specific health care needs, developing engagement strategies and care plans.
3. Collaborate with Primary Care Case Management and other entities, sharing information and participating in care team meetings.
4. Facilitate communication and coordination between various care providers and entities.
5. Ensure documentation compliance, quality care, and safety standards.
6. Participate in multidisciplinary team meetings and other high-risk case discussions.
7. Maintain electronic health records and ensure all documentation meets standards.

Knowledge, Skills & Abilities

• Excellent communication, relationship-building, organizational, and problem-solving skills.
• Proficiency in Microsoft Office and Vaya systems.
• Knowledge of Medicaid waivers, service array, and relevant regulations.
• Ability to work independently and adapt to changing priorities.
• Understanding of behavioral health, developmental disabilities, and related service provision.

Qualifications & Education:

Bachelor's degree in health, psychology, sociology, social work, nursing, or related field, and two years of relevant experience, or equivalent combination of education and experience.

Licensed RN in North Carolina with four years of relevant experience also qualifies.

Licensure/Certification:

RN licensure in North Carolina or relevant professional credentials.

Physical Requirements:

• Visual acuity, mobility, and ability to perform physical activities as described.

Residency Requirement:

Must reside in North Carolina or within 40 miles of the border.

Salary:

Dependent on qualifications and experience. Position is non-exempt, eligible for overtime.

Application Deadline:

Open until filled.

Apply:

Online via Vaya Health Careers.

Vaya Health is an equal opportunity employer.