Care Coordinator

4 weeks ago


Greenwood, South Carolina, United States Professional Management Enterprises Full time
Job Summary

The Care Coordinator will oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC).

The ideal candidate will be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program.

The Care Coordinator will be responsible for overseeing care coordination teams, care plan development and care plan implementation. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members.

The Care Coordinator will provide input, as requested by the State, at State-level meetings.

Key Responsibilities:

Selects, manages, develops, mentors and supports staff in designated department or region

Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results

In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements

Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements

Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care

Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services

Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members

Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team

Participates in training and coaching of direct reports as needed

Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship

Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders

Required Qualifications:

Resident of Indiana

BSN with equivalent experience

Registered Nurse with an unrestricted License in Indiana

Experience working within the community health setting in a health care role

Experience or knowledge of Indiana Medicaid, Medicare, Long term care

Experience coaching or mentoring staff

Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment

Preferred Qualifications:

3+ year of case management leadership experience within a healthcare industry

Background in managed care

Case Management experience

Certified Case Manager (CCM)

Experience / exposure with members receiving long term social supports

Experience in utilization review, concurrent review and/or risk management

PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.



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