Case Management Coordinator

Case Management Coordinator

**Position is fully onsite Mon-Friday, Bilingual in Spanish is required**

Location: 9250 NW 36th St, Miami, FL 33178

About us

Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued.

POSITION SUMMARY

Case Management Care Coordinators are instrumental in helping members manage their health by serving as a liaison between the health plan’s Case Management Department and the member’s health care providers. Case Management Care Coordinators perform their duties as an extension of the case management team to ensure components identified as part of the member’s care are addressed and arranged. The Case Management Care Coordinator provides support by outreaching to members and ensuring their needs are met. In addition, the Case Management Care Coordinator will gather key elements of information that will allow others within the department as well as other departments to provide exceptional customer care through attention to detail, attentive and empathetic communication, and follow-up that may be needed for optimal healthcare experiences. This requires a flexible attitude, quick thinking and a caring disposition. Day-to-day activities may vary based on member needs and departmental requirements, but can involve the following tasks and responsibilities:

ESSENTIAL DUTIES & RESPONSIBILITIES

• Performs member screening through health risk assessment completion
• Completes interventions as determined by member’s individualized care plan
• Schedules appointments in support of care plan goals
• Ability to professionally communicate with nurses and physicians both internal and external to organization
• Handles inbound calls and answers member questions
• Connects with members via phone as well as alternate communication methods
• Is familiar and coordinates with community resources that will support interventions on member’s individualized care plan
• Ability to document within the member’s electronic record
• Assist the case management team with support and follow-up of interventions and actions
• Ensures compliance with all regulatory requirements inclusive of HIPAA, OSHA, and other federal, state, and local regulations
• Helps with data collection
• Maintains a polite and professional demeanor at all times
• Maintains patient confidentiality at all times
• Must be able to work within a high-paced and demanding environment
• Must be able to multi-task and prioritize appropriately
• Assists with training of new staff members
• Performs other duties and projects as assigned

QUALIFICATIONS & EDUCATION
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.
• Fast-paced office environment.
• Highly regulated environment.
• Time frames are in accordance with CMS, NCQA, and internal operations/ compliance driven.
• Interact with providers, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.

This work requires the following physical activities: climbing, bending, stooping, kneeling, twisting, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lift, and moves intermittently during working hours.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must be able to frequently lift up to 30 pounds and occasionally lift and/or move up to 50 pounds. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required to this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

LANGUAGE REQUIREMENTS

• Bilingual English/Spanish

PERFORMANCE MEASUREMENTS

• Duties accomplished timely and efficiently
• Attendance/punctuality
• Compliance with company and regulatory agency regulations
• Safety and security
• Quality

This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.

Solis Health Plans provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Type: Full-time

Benefits:

• 401(k) & 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance