Community Based Care Coordinator - Nevada

• Assists enrollees with understanding health plan processes, appeals and grievances and assist with removing barriers to getting needed services.

• Conducts routine outreach to members and providers to confirm service details, coordinates services with long term services and supports teams, serves as a health plan subject matter expert and accurately documents care coordination activities.

• Regular travel to conduct member visits, provider visits and community-based visits as needed to ensure effective administration of the program.

• Maintain open lines of communication with enrollees, as needed based on Enrollee preferences.

• Maintains accurate and timely documentation and internal systems to ensure visibility across teams and continuity of service.

• Coordinates provider and member scheduling efforts, supports high-volume outreach campaigns, and ensures task completion across multiple systems.

• Identify and implement effective interventions based on opportunities identified in members plan of care.

• Participate in development of an individualized care plan (ICP) in collaboration with the ICT, based on member's needs and preferences.

• Educate the member/caregivers about risk conditions, community resources, insurance benefits, etc. so that timely and informed decisions can be made.

• Serves as a support resource for enrollees and providers, and escalate concerns by coordinating responses and ensuring issues are routed or addressed promptly

• Collaborates with clinical care managers, behavioral health clinicians, community health workers, providers, and external partners as needed to ensure smooth communication and continuity across care activities.

• Gather and document service-related information during members interaction to support care coordination, service planning, or referral processes.

• Maintain accurate documentation and maintenance of the centralized enrollee records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners as needed.

• Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements.

• Ensure enrollees follow up with providers, including assistance with appointment scheduling and verification of transportation.

• Facilitate communication and information exchange with the member and their providers and community supports.

• Perform any other job related duties as requested.

Education and Experience:

• Associates of Science (A.S) in a healthcare related field required

• Bachelor of Science (B.S) in a healthcare related field preferred

• Three (3) years of experience in a healthcare field (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) required

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel

• Knowledge of Medicaid, Medicare and Managed Care is preferred

• Customer service focus with exceptional listening, written and verbal communication skills

• Displays professional phone etiquette

• Ability to multitask using a variety of computer applications

• Strong organizational skills and time management skills

• Effective problem solving skills with attention to detail

• Ability to work independently and within a team environment

• Understanding and supportive of managed care concept

• Adaptable to a constantly changing environment

• Able to type (document) and talk (telephonically) simultaneously

• Developing knowledge of local, state and federal healthcare laws and regulations and all company policies regarding case management practices

• Strong understanding and respect of all cultures and demographic diversity

• Awareness of community & state support resources

• Strong advocate for members at all levels of care

• Strong analytical, problem solving, and critical thinking skills, with attention to detail

Licensure and Certification:

• Behavioral or mental health certification or equivalent approved training program preferred

• Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated

• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.

• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential.
  Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
  Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need
  May be required to travel greater than 50% of time to perform work duties.
  Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer
  Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members

• Over 50% (Mobile) Routine travel required