Case Management Coordinator
2 weeks ago
Case Management Coordinator
**Position is fully onsite Mon-Friday, Bilingual in Spanish is required**
Location: 9250 NW 36th St, Miami, FL 33178
About us
Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued.
POSITION SUMMARY
Case Management Care Coordinators are instrumental in helping members manage their health by serving as a liaison between the health plan’s Case Management Department and the member’s health care providers. Case Management Care Coordinators perform their duties as an extension of the case management team to ensure components identified as part of the member’s care are addressed and arranged. The Case Management Care Coordinator provides support by outreaching to members and ensuring their needs are met. In addition, the Case Management Care Coordinator will gather key elements of information that will allow others within the department as well as other departments to provide exceptional customer care through attention to detail, attentive and empathetic communication, and follow-up that may be needed for optimal healthcare experiences. This requires a flexible attitude, quick thinking and a caring disposition. Day-to-day activities may vary based on member needs and departmental requirements, but can involve the following tasks and responsibilities:
ESSENTIAL DUTIES & RESPONSIBILITIES
- Performs member screening through health risk assessment completion
- Completes interventions as determined by member’s individualized care plan
- Schedules appointments in support of care plan goals
- Ability to professionally communicate with nurses and physicians both internal and external to organization
- Handles inbound calls and answers member questions
- Connects with members via phone as well as alternate communication methods
- Is familiar and coordinates with community resources that will support interventions on member’s individualized care plan
- Ability to document within the member’s electronic record
- Assist the case management team with support and follow-up of interventions and actions
- Ensures compliance with all regulatory requirements inclusive of HIPAA, OSHA, and other federal, state, and local regulations
- Helps with data collection
- Maintains a polite and professional demeanor at all times
- Maintains patient confidentiality at all times
- Must be able to work within a high-paced and demanding environment
- Must be able to multi-task and prioritize appropriately
- Assists with training of new staff members
- Performs other duties and projects as assigned
QUALIFICATIONS & EDUCATION
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The noise level in the work environment is usually moderate.
- Fast-paced office environment.
- Highly regulated environment.
- Time frames are in accordance with CMS, NCQA, and internal operations/ compliance driven.
- Interact with providers, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.
Benefits:
- 401(k) & 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
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