Senior Care Coordinator – Hybrid In-Home Support

Genevive Llc.; Minneapolis (MN); Hybrid; USD 68,000 - 94,000; Full time

Job summary

Kids for the Future in the Minneapolis west metro seeks a Care Coordinator for the MSHO program to provide comprehensive, person-centered care for elderly and dual-eligible individuals. You will perform assessments, develop care plans, coordinate services, and support transitions across home and community settings.

Work within CMS and DHS rules, collaborate with the care team, and advocate for members’ health, safety, and quality of life with diligent documentation.

Qualifications

• Proficiency with clinical documentation tools, Happian, and Microsoft Office.
• Motivational interviewing and cultural competency required.
• Valid driver’s license, reliable transportation, and ability to conduct in-home visits.
• Mandated reporter.

Responsibilities

• Provides comprehensive assessment or screening of each member’s social, medical and environmental safety needs. Documents information in a timely manner on appropriate forms.
• Conducts required in person and telephonic visits on a timely basis.
• Performs review of medical records in the appropriate EMR.
• Develops Person Centered Care Plans based on assessment requirements, maximizing the level of self-determination and member choice of services, service providers, and living arrangements to meet identified needs. This includes disease management, advance directive planning, and vaccination updates.
• Incorporates interdisciplinary, holistic, and preventive care across all settings of care per CMS timeline.
• Provides culturally appropriate care.
• Communicates care needs and plan of care with members and/or member representatives, primary physicians, and interdisciplinary team members through written and/or verbal communication.
• Contacts appropriate personnel in hospital, nursing facility, foster care or assisted living settings to share and obtain necessary information that will facilitate discharge of the member to the appropriate level of care.
• Communicates with service providers and members while assisting with arrangement and authorization of services and issue denials of inappropriate services in a timely manner.
• Interdisciplinary collaboration with population health team when members have complex medical needs.

Skills

Clinical documentation tools

Happian

Microsoft Office

Tools

Happian

Job description

Kids for the Future in the Minneapolis west metro seeks a Care Coordinator for the MSHO program to provide comprehensive, person-centered care for elderly and dual-eligible individuals. You will perform assessments, develop care plans, coordinate services, and support transitions across home and community settings.

Work within CMS and DHS rules, collaborate with the care team, and advocate for members’ health, safety, and quality of life with diligent documentation.