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Care Coordinator

2 months ago

Greenwood, Indiana, United States Professional Management Enterprises Full time
Job Title: Care Coordinator

The Community Well Care Coordinator plays a vital role in overseeing care coordination and complex case management functions for PathWays to Aging members residing in the community and not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC).

Key Responsibilities:
  • Select, manage, develop, mentor, and support staff in designated departments or regions.
  • Develop clear goals and objectives for performance management and effectively communicate expectations, holding the team accountable for results.
  • Ensure an intimate understanding of contractual requirements to meet the unique needs of members.
  • Identify, select, structure, and prioritize process improvement projects, implementing changes to meet program requirements.
  • Ensure standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence.
  • Assess, plan, and implement care strategies tailored to individual patients, 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 stakeholders to ensure quality coordinated care and services are provided expeditiously to all members.
  • Advocate for patients and families as needed to ensure their needs and choices are fully represented and supported by the healthcare team.
  • Participate in training and coaching of direct reports as needed.
  • Conduct bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns, and foster a good working relationship.
  • Collaborate across Optum and UHG, interacting 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 healthcare 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+ years 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.

Professional Management Enterprises 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.