Managed Care Coordinator

7 hours ago


Richmond, California, United States Elevance Health Full time
Job Summary:

The Managed Care Coordinator is responsible for the overall management of a member's individual service plan within the scope of the position, as required by applicable state law and contract. This role involves performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions to identify, evaluate, coordinate, and manage a member's program needs.

Key Responsibilities:
  • Responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination, and management of a member's program needs.
  • Identifies members with potential clinical healthcare needs and coordinates those member's cases with the clinical healthcare management and interdisciplinary team to provide care coordination support.
  • Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of services.
  • Establishes short and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
  • Identifies members that would benefit from expanded services.
Requirements:
  • Requires a BA/BS degree and a minimum of 1 year of experience working directly with people related to the specific program population or other related community-based organizations.
  • Specific education and years and type of experience may be required based upon state law and contract requirements.
Preferred Skills:
  • BA/BS degree field of study in a healthcare-related field is preferred.
  • Prior case management experience is strongly preferred.
  • Prior experience working with individuals with behavioral health issues and/or developmental disabilities is preferred.
  • Experience with community services boards is preferred.
  • QMHP is strongly preferred.


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