Job Description

Duties
Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
Conducts comprehensive evaluation of Members using care management tools and information/data review
Coordinates and implements assigned care plan activities and monitors care plan progress
Conducts multidisciplinary review to achieve optimal outcomes
Identifies and escalates quality of care issues through established channels
Utilizes negotiation skills to secure appropriate options and services necessary to meet the members benefits and/or healthcare needs
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
Helps member actively and knowledgeably participate with their provider in healthcare decision-making
Monitoring, Evaluation and Documentation of Care:
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Experience
Case management experience required
Long term care experience preferred
Microsoft Office including Excel competent

Position Summary
Location: Work from Home. Candidates must reside in zip codes noted above in Miami Dade County, FL.
Training will be conducted remotely via Microsoft Teams for approximately 1-2 weeks.
Candidate will travel approximately 75% of the time within the region seeing
Members at home, in assisted living facilities and nursing homes.

Required:
Fluent bilingual Spanish / English

Preferred Qualifications:
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written

Education
Bachelors degree required. No nurses. Social work degree or related field.

What days & hours will the person work in this position List training hours, if different.
M-F 8am-5pm

Job Tags

Work at office, Work from home

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