Clinical Care Coordinator II
2 weeks ago
The Clinical Care Coordinator II is tasked with managing care for members facing intricate and chronic health challenges. This role involves evaluating, formulating, executing, coordinating, supervising, and assessing care strategies aimed at enhancing member health outcomes throughout the healthcare continuum.
Key Responsibilities:
1. **Facilitating Access to Services:**
- Ensures that members receive appropriate services tailored to their health requirements.
2. **Conducting Comprehensive Assessments:**
- Identifies individual needs and develops a targeted care management strategy to meet established objectives and goals.
3. **Implementing Care Plans:**
- Executes care plans by coordinating authorizations and referrals as necessary within the benefits framework or through alternative arrangements.
4. **Resource Coordination:**
- Collaborates with both internal and external resources to address identified needs effectively.
5. **Monitoring and Evaluation:**
- Continuously assesses the effectiveness of the care management strategy and makes adjustments as required.
6. **Collaboration with Medical Professionals:**
- Engages with Medical Directors and Physician Advisors to develop comprehensive care management treatment plans.
7. **Problem Resolution:**
- Assists in resolving issues related to providers, claims, or service delivery.
8. **Participation in Team Initiatives:**
- Actively participates in departmental meetings, training sessions, and contributes to departmental projects and initiatives.
Qualifications:
- A Bachelor’s degree in a health-related discipline is required, along with a minimum of five years of clinical experience, or an equivalent combination of education and experience.
- A current, unrestricted RN license in the relevant state(s) is mandatory.
- Multi-state licensure is necessary for those providing services across multiple jurisdictions.
Preferred Skills and Experience:
- Experience in maternal and child case management or behavioral health case management is highly desirable.
- A background in managed care and/or case management for 2-3 years is beneficial for effective job performance.
- Familiarity with Medicaid populations is advantageous.
- Proficiency in telephonic communication is essential, as approximately 50% of the role involves handling inbound and outbound calls.
- Experience with InterQual (IQ), Milliman Care Guidelines (MCG), or similar criteria for determining medical necessity is preferred.
- Certification as a Case Manager is a plus.
- Strong written and verbal communication skills are essential.
- Excellent time management and project management abilities are necessary to balance various tasks and projects efficiently.
Compensation and Benefits:
- The salary range for this position is competitive and based on various legitimate factors.
- Elevance Health offers a comprehensive benefits package, including incentive programs, stock purchase options, and 401k contributions, subject to eligibility requirements.
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