Direct Hire position
Must be fluent in Spanish and English
Day to Day responsibilities will include: Telephonic Case Management, Computer, Outlook, Microsoft Office (Word & Excel) Must have excellent organizational skills and able to prioritize workload.
Summary: Responsible for health care management and coordination of Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors Molina member’s progress and services to ensure consistent cost effective care that complies with Molina policy and all state and federal regulations and guidelines.
- Provides case management services to members with chronic or complex conditions including:
- Proactively identifies members that may qualify for potential case management services. o Conducts assessment of member needs by collecting in-depth information from information system, the member, member’s family/caregiver, hospital staff, physicians and other providers.
- Identifies, assesses and manages members per established criteria.
- Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
- Performs ongoing monitoring of the plan of care to evaluate effectiveness. o Documents care plan progress in information system.
- Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
- Measures the effectiveness of interventions to determine case management outcomes.
- Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for members.
- Conducts face to face or home visits as required.
- Maintains department productivity and quality measures.
- Manages and completes assigned work plan objectives and projects in a timely manner.
- Demonstrates dependability and reliability.