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Managed Care Coordinator
1 month ago
The Managed Care Coordinator is responsible for the overall management of members' individual service plans 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 members' program needs.
Key Responsibilities:
• Perform telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions to identify, evaluate, coordinate, and manage members' program needs.
• Identify members with potential clinical healthcare needs and coordinate their cases with the clinical healthcare management and interdisciplinary team to provide care coordination support.
• Manage non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of services.
• Establish short and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
• Identify members who would benefit from expanded services.
Requirements:
• Bachelor's degree in a healthcare-related field or equivalent experience.
• 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 of experience may be required based on state law and contract requirements.
Preferred Skills:
• Prior case management experience.
• Prior experience working with individuals with behavioral health issues and/or developmental disabilities.
• Experience with community services boards.
• QMHP (Qualified Mental Health Professional) certification.
Work Environment:
This role is primarily remote, with occasional travel to meet with members face-to-face. The candidate must reside within 50 miles of Richmond, VA.
