Job Description

This role will require 5075% travel for face to face visits with members. Must reside in zip codes 33142, 33147, 33127, 33125 of Miami Dade County, FL.
Mileage is reimbursable.
Do Not Cross Submit Candidates For South Florida Postings.
Must Be Fluent In English And Spanish
Must reside in one of the zip codes below
Add city state and zip at top of resume
We are seeking selfmotivated, energetic, detail oriented, highly organized, techsavvy Case Management Coordinator to join our Case Management team in MiamiDade County, FL. Must reside in zip codes 33142, 33147, 33127, 33125.
Our organization promotes autonomy through a Monday Friday, 8:00AM 5:00PM working schedule and flexibility as you coordinate the care of your members. Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the members overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and medically complex members. Develops a proactive course of action to address issues presented to enhance the short and longterm outcomes as well as opportunities to enhance a members overall wellness through integration. Case Management Coordinators will determine appropriate services and supports due to members health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and suppots.

Duties
Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Conducts comprehensive evaluation of members using care management tools and information/data review. Coordinates and implements assigned care plan activities and monitors care plan progress. Conducts multidisciplinary review to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. Utilizes negotiation skills to secure appropriate options and services necessary to meet the members benefits and/or healthcare needs. Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Helps member actively and knowledgeably participate with their provider in healthcare decision making. Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Experience
Case Management experience required. Long Term Care experience preferred. Microsoft Office experience required: Excel, Teams, Outlook.

Position Summary
Location: Work from Home. Training will be conducted remotely via Microsoft Teams.
Candidates must reside in Miami Dade County.
Bilingual (Spanish, English) Fluent speaking and writing.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
Effective communication skills, both verbal and written.
Candidate will travel approximately 75% of the time within Miami Dade County visiting members at their homes, in Assisted Living Facilities and Skilled Nursing Facilities.

Education
Bachelors degree in social work or related field required. No Nurses.
What days & hours will the person work in this position List training hours, if different.
Monday Friday / 8:00AM 5:00PM

Job Tags

Work at office, Remote work, Work from home, Monday to Friday

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