Job Details & Requirements
- Candidates MUST be in Miami Dade county in one of these zip codes (33126, 33125, 33015, 33018, 33133)
- This role will require 75% travel for face-to-face visits with members in Miami Dade.
- Schedule is Monday-Friday, 8:00 am-5:00 pm, standard business hours.
- Bachelor’s degree required – No Nurses.
- Required to be FLUENT in English and Spanish
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, 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 a 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 member’s benefits and/or healthcare needs
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve the optimum level of health
- Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
- Help members 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
Skills & Experience
- Case management experience required
- Long-term care experience preferred
- Ability to multitask, prioritize, and effectively adapt to a fast-paced, changing environment
- Microsoft Office, including Excel, TEAMS, screen share, and Word
- FLUENT IN SPANISH (WRITTEN, VERBAL, AND READING)
Education
- Bachelor’s degree required – No Nurses. Social Work degree or related field
Schedule
Monday – Friday: 8 am – 5 pm.
Job Pay Rate: $34.00