Managed Care Coordinator
Elevance Health

Job Info

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Managed Care Coordinator

Location: Candidate must reside within 50 miles of Richmond, VA. While primarily remote, occasional travel to meet with members face to face is required.

The Managed Care Coordinator is responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract.

How you will make an impact:

• Responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination and management of member's program needs.
  
• Using tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order to provide care coordination support. The process does not involve clinical judgment.
  
• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of services.
  
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
  
• Identifies members that would benefit from expanded services.
  

Minimum Requirements:

• Requires BA/BS degree and a minimum of 1 year of experience working directly with people related to the specific program population or other related community based organizations; or any combination of education and experience which would provide an equivalent background.
  
• Specific education and years and type of experience may be required based upon state law and contract requirements.
  

Preferred skills, capabilities, and experiences:

• BA/BS degree field of study in health care related field preferred.
  
• Prior case management experience strongly preferred.
  
• Prior experience working with individuals with behavioral health issues and/or developmental disabilities preferred.
  
• Experience with community services board preferred.
  
• QMHP strongly preferred.
  

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