BusinessOperations – Care Coordinator III Care Coordinator III Position Available In [Unknown county], South Carolina

BusinessOperations – Care Coordinator III Care Coordinator III#25-51857
Various, SC
All On-site Job Description

Job Description:

Position Purpose:

Works with senior care management team to support care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Serves as a liaison alongside care managers and providers to ensure proper coordination of care for members and interacts with members by performing member outreach telephonically or through home-visits.

Education/Experience:

Requires a High School diploma or GED
Requires 2 – 4 years of related experience

License/Certification:

For Illinois Youth Care Contract:

Bachelor’s degree in nursing, social sciences, social work, or related field; One (1) year of supervised clinical experience in a human-services fieldProvides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plans Develops in-depth knowledge of care management services including responding to some complex or escalated issues Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care Performs service assessments/screening for members with some complex needs and documents the member’s care needs. Documents and maintains member records in accordance with state and regulatory requirements and distribution to providers as needed Works with care management team with triaging, adjusting, and escalating complex requests to management Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards Ability to identify needs and make referrals to Care Manager, community cased organizations, and Disease Manager Provide education on benefits and resources available May assist with training and development needs
Performs other duties as assigned Complies with all policies and standards
Comments for

Vendors:

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.” ========= Centene Job Description Story Behind the Need – Business Group & Key Projects Health plan or business unit
Team culture
Surrounding team & key projects
Purpose of this team
Reason for the request
Motivators for this need
Any additional upcoming hiring needs? Absolute Total Care
Close team bond atmosphere in a remote setting
Quality Improvement Team
This team makes outbound calls to members to provide healthy reminders and encourage appointments Typical Day in the Role Daily schedule & OT expectations
Typical task breakdown and rhythm
Interaction level with team
Work environment description The daily workday starts at 8:00 and ends at 5:00 with 2 20-minute paid breaks and 1 60-minute unpaid lunch break.
Email, chats
Close team bond atmosphere in a remote setting Compelling Story & Candidate Value Proposition What makes this role interesting?
Points about team culture
Competitive market comparison
Unique selling points
Value added or experience gained The members of this team have a passion for people, engagement, and quality of life. We are constantly adapting to and learning about health care changes to provide better outcomes for our outreach efforts.
N/A Candidate Requirements
Education/Certification High School diploma

Preferred:

N/A
Licensure N/A

Preferred:

N/A Years of experience required
Disqualifiers
Best vs. average
Performance indicators Must haves: 2+ years of call center experience, preferably in healthcare.

Nice to haves:

HEDIS, STARS, CAHPS, NCQA

, MEDICARE and/or

MEDICAID

experience

Disqualifiers:

Distractions during interview, being unprofessional and not camera ready for interview, not being able to answer questions properly, job hopping, TBD etc Performance indicators: Make 70 calls/day (10 calls per productive hour); Maintain 99.5% quality score; adhere to attendance guideline Best vs.

average:

N/A Top 3 must-have hard skills
Level of experience with each
Stack-ranked by importance
Candidate Review & Selection 1 SEE ABOVE
2 Strong verbal communication and phone presence; strong written communication skills
3 Candidate Review & Selection Shortlisting process
Second touchpoint for feedback
Interview Information

Onboard Process and Expectations Projected HM Candidate Review Date:

48 business hours after receiving resumes

Number and Type of Interviews:

1 (TEAMS)
Extra Interview Prep for

Candidate:

N/A
Required Testing or Assessment (by Vendor): N/A
Manager Communication Preferences & Steps Background Check Requirements (List DFPS or other specialty checks here) N/A Do you have any upcoming PTO? N/A Colleagues to cc/delegate N/A