About The Opportunity
We are seeking dedicated Clinical Care Coordinators (Licensed Registered Nurses) to become integral members of our team. This role involves managing a caseload of enrollees and ensuring they receive the necessary support and care.
Key Responsibilities
- Manage a caseload according to Care Management Leadership guidelines.
- Regularly contact enrollees based on their stratification level or as needed.
- Conduct face-to-face visits with enrollees and caregivers in their homes, physician's offices, or other agreed-upon locations.
- Assess enrollees during enrollment and at specified intervals to identify needs, barriers, and gaps in care.
- Perform routine care coordination and management activities to ensure quality and compliance with organizational policies and national standards.
- Collaborate with the Senior Care Manager to review cases, set objectives, and identify potential risks and utilization concerns.
- Seek guidance from the Senior Care Manager or specialists when needed.
- Accurately document enrollee interactions and findings, adhering to organizational policies.
- Maintain confidentiality regarding specific enrollee information.
- Participate in discharge planning activities to contribute to timely discharge plans considering enrollee and family needs.
- Communicate information clearly, both verbally and in writing.
- Educate enrollees and caregivers on the importance of EPSDT and promote compliance with health services.
- Apply advanced knowledge of target population conditions and care management approaches.
- Review vendor reports for enrollees receiving services and facilitate necessary follow-up care.
- Refer enrollees to appropriate vendors for DME/assistive technology and educate them on medication administration and self-management techniques.
- Assist enrollees in planning for transitions of care, including from Early Intervention to DC Public Schools and from pediatric to adult providers.
- Enter authorizations for services requiring approval from Care Management staff.
- Foster understanding and collaboration through effective communication with enrollees, families, providers, and others.
- Maintain a professional and courteous demeanor in all interactions.
- Demonstrate knowledge of medical terminology and healthcare delivery systems.
- Utilize strong time management and organizational skills effectively.
Qualifications
- 3-5 years of relevant experience in managed care and/or care management.
- 3-5 years of experience in clinical or community resource settings.
- Strong verbal and written communication skills; bilingual (Spanish-speaking) preferred.
- Familiarity with medical terminology and computer systems, particularly the Microsoft Office suite.
- Excellent organizational skills and ability to interpret departmental requirements.
- Sound decision-making skills and good judgment.
- Ability to work under pressure and meet deadlines while providing exceptional customer service.
- Experience participating in professional multidisciplinary meetings, both internal and external.
Licenses/Certifications
- Licensed in DC as a Social Worker (LICSW) or Registered Nurse (RN).
- Certification as a Case Manager is preferred.
Education
- Associate's degree required; Bachelor's degree preferred.
Work Environment
- This position involves moderate mental and visual stress along with concentrated periods spent using a PC keyboard and viewing a monitor. Flexibility to work some weekends, evenings, or early hours to accommodate member needs may be required.
Equal Opportunity Employer
- We are committed to fostering a diverse work environment and are proud to be an equal opportunity employer. We do not discriminate on the basis of race, creed, color, religion, gender, sexual orientation, gender identity, pregnancy, national origin, citizenship status, age, disability, medical condition, genetic information, marital status, status as a covered veteran, or any other characteristic protected by federal, state, and/or local law.
Employment Type: Full-Time