Special Needs Coordinator

🌍 Remote, USA 🎯 Full-time 🕐 Posted Recently

Job Description

About the position

Coordinate care for highly complex members as part of an inter-disciplinary care team approach
Consult and collaborate with local health departments, primary care providers, Federally Qualified Health Centers (FQHCs), social service agencies, and specialty care services to address member complex care needs
Manage referrals to the REM (Rare and Expensive Medical special needs care management) program, including outreach, education, and coordination of member transfer
Serve as a liaison with the MDH REM office
Ensure appropriate re-direct for members to in-network specialty services, working closely with the Prior Authorization team
Act as a Housing coordinator, requiring understanding of county-based resources
Educate Local Health Departments and Community Advisory Committee attendees about Plan programs and services
Represent Special Needs Members at Plan's Quarterly Consumer Advisory Board

Current unrestricted nursing license (e.g., LPN, LVN) OR Bachelor's level Social Worker (licensed or non-licensed) with work experience in a health care setting
3+ years of experience in a clinical or managed care setting
Experience with care coordination or case management
Experience with arranging community resources
Experience providing clinical care to low-income populations
Understanding of Medicaid member needs and benefits
Computer/typing proficiency to enter/retrieve data in electronic clinical records and documentation systems; experience with email, internet research, use of online calendars and other software applications
Proficient with Excel to create and pull reports

5+ years of experience in a clinical or managed care setting
Experience and comfortability collaborating with providers and State partners
Experience with EMR [Electronic Medical Records] and care management platforms including the State Health Information Exchange [CRISP]
Proven ability to think creatively and work comfortably within a hands-on, fast-paced, high-demand environment
Proven ability to work with diverse care teams in a variety of settings
Proven ability to exhibit independent clinical judgment, but the ability to consult and engage with other team members for improved patient outcomes
Proven excellent administrative, organizational and verbal skills
Proven effective time management and prioritization skills for competing demands
Proven comfort with ambiguity, willingness to adjust as demands change and evolve