Description
Are you a dedicated Licensed Clinical Social Worker looking to make a meaningful impact in the lives of individuals and families? We are seeking compassionate Clinical Care Coordinators to join our team in the District of Columbia. In this role, you will have the opportunity to work primarily remotely while managing a caseload and providing essential support to enrollees.
Responsibilities
- Manage a caseload as outlined by Care Management Leadership, ensuring timely and effective support.
- Connect with enrollees at regular intervals based on their stratification level and reach out more frequently as needed.
- Conduct face-to-face visits in enrollees' homes, physician's offices, or other mutually agreed-upon locations, following the frequency guidelines based on their stratification level.
- Assess enrollees upon enrollment and at designated intervals to identify needs, barriers, and gaps in care.
- Perform routine care coordination and management activities with a focus on quality and compliance with organizational policies and national standards.
- Collaborate with the Senior Care Manager to review and prioritize cases, set objectives, and identify potential risks and utilization concerns.
- Seek guidance from the Senior Care Manager or other specialists when necessary.
- Document enrollee findings and interactions accurately and promptly according to organizational policies.
- Adhere to confidentiality policies regarding enrollee-specific information.
- Participate in discharge planning activities, contributing to discharge plans with the enrollee, family, and healthcare resources in mind.
- Communicate clearly and effectively, both verbally and in writing.
- Support enrollees and caregivers in understanding the importance of EPSDT and compliance with health services, striving to achieve target compliance rates for preventive medical and dental services.
- Apply your knowledge of the target population and standard care management approaches to provide excellent support to enrollees.
- Review vendor reports and facilitate coordination of follow-up care as needed.
- Refer enrollees and caregivers to appropriate vendors for DME/assistive technology and educate them on medication administration and self-management techniques within your scope of practice.
- Assist enrollees in planning transitions of care, such as moving from pediatric to adult providers or transitioning out of health plans.
- Enter service authorizations as required by Care Management staff.
- Utilize communication skills to foster understanding and collaboration among enrollees, families, providers, and other stakeholders.
- Maintain a professional, courteous, and customer-focused demeanor in all interactions.
- Demonstrate knowledge of medical terminology and healthcare delivery systems.
- Effectively manage your time and stay organized.
Qualifications
- 3-5 years of experience in managed care and/or care management.
- 3-5 years of experience in clinical or community resource settings.
- Effective verbal and written communication skills; bilingual (Spanish) preferred.
- Familiarity with medical terminology and computer systems, especially Microsoft Office.
- Strong organizational skills with the ability to interpret and apply departmental requirements.
- Capable of making sound decisions and exercising good judgment under pressure.
- Positive attitude and exemplary customer service skills.
- Ability to participate in professional, multidisciplinary meetings with internal and external staff.
License/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 may involve moderate mental and visual stress due to concentrated periods of computer use. Some weekends, evenings, or early hours may be required to accommodate member needs.
Equal Opportunity Employer
We are committed to fostering a diverse and inclusive workplace. We do not discriminate on the basis of race, creed, color, religion, gender, sexual orientation, gender identity, pregnancy, national origin, age, disability, medical condition, genetic information, marital status, military discharge status, or any other characteristic protected by law.
Employment Type: Full-Time