BusinessOperations - Care Coordinator II

BusinessOperations

• Care Coordinator II#26-09123 Remote-TX, TX

All On-site Job Description Position Purpose:

Supports 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. Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities.

Education/Experience:

Requires a High School diploma or GED Requires 1

• 2 years of related experience

License/Certification:

For Florida-Sunshine Health Plan

• All interactions with members are done telephonically. For Arkansas Total Care plan
• This position is designated as safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment check (before hire and recurring), and a drug screen (at time of hire and recurring).

Must reside in AR or border city.

Travel:

30%. required" "Provides 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 plan Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service May support performing service assessments/screenings for members and documenting the member's care needs Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed 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 based organizations, and Disease Manager Provide education on benefits and resources available Performs other duties as assigned. Complies with all policies and standards. ==================

Position Purpose:

Supports 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. Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities.

Education/Experience:

Requires a High School diploma or GED Requires 1

• 2 years of related experience

License/Certification:

For Florida-Sunshine Health Plan

• All interactions with members are done telephonically. For Arkansas Total Care plan
• This position is designated as safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment check (before hire and recurring), and a drug screen (at time of hire and recurring).

Must reside in AR or border city.

Travel:

30%. required" "Provides 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 plan Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service May support performing service assessments/screenings for members and documenting the member's care needs Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed 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 based organizations, and Disease Manager Provide education on benefits and resources available Performs other duties as assigned. Complies with all policies and standards. Story Behind the Need What is the purpose of this team? Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative? Non

• Waiver Scheduler
• schedule an Annual Reassessment Thirty days before the end date of annual 2060
• the MCO must complete the same activities detailed in section 8.

3.3.2 non waiver for each reassessment to determine and validate continued eligibility for non-waiver services for each member receiving these services and submit the members 2060 to the state. Typical Day in the Role Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique? Individual will be contacting member telephonically

• like working in a call center
• making outbound calls and receiving inbound call Individuals are expected to Contact minimum of 28 members daily maintain audit score of 95% on a monthly bases SHP Candidate Requirements Education/Certification

Required:

HSD/GED

Preferred:

Licensure

Required:

Preferred:

Years of experience required: 1-2 years Medical or similar experience. Any medical experience is accepted. i.e. nursing homes, call center for insurance

Disqualifiers:

n/a Additional qualities to look for: Top 3 must-have hard skills stack-ranked by importance 1 Knowledge of computer and associated software 2 Call center experience

• Fast pace 3 Knowledge of Medicaid/ Bilingual preferred