Care Coordinator for Long-term Care

4 weeks ago


Dover, Delaware, United States Highmark Health Full time
Job Summary

This role serves as the primary point of contact for members to coordinate all of their care needs across various service delivery systems and community supports. The successful candidate will travel frequently within the assigned territory in DE, visiting members' homes, nursing facilities, and other community-based settings to provide face-to-face needs assessments and subsequent telephonic contact.

Key Responsibilities
  • Conduct comprehensive needs assessments with members to identify their care requirements and develop personalized plans of care.
  • Coordinate care across the continuum of services, ensuring that members receive the most cost-effective and least restrictive care possible.
  • Facilitate authorization, coordination, and continuity of care, working closely with healthcare providers, community resources, and family members to ensure seamless transitions.
  • Provide education and support to members and their caregivers, empowering them to make informed decisions about their care.
  • Develop and implement plans of care that address members' physical, behavioral, and social needs, ensuring that they receive the necessary resources and services to achieve optimal health outcomes.
  • Collaborate with healthcare teams, including primary care physicians, specialists, and other healthcare professionals, to ensure that members receive comprehensive and coordinated care.
  • Monitor and evaluate the effectiveness of care plans, making revisions as needed to ensure that members receive the best possible outcomes.
Requirements
  • Bachelor's degree in Social Work or a related field, or equivalent experience.
  • At least 3 years of experience in long-term care, home health, hospice, public health, or assisted living.
  • Strong communication and interpersonal skills, with the ability to work effectively with diverse populations.
  • Ability to travel frequently within the assigned territory, with reliable transportation.
  • Proficiency in electronic documentation systems and other relevant software.
Preferred Qualifications
  • Master's degree in Social Work or a related field.
  • Experience working with geriatric populations, including those with complex and chronic conditions.
  • Certification as a Case Manager (CCM) or other relevant certifications.
  • Experience working with electronic documentation systems and other relevant software.


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