Job Summary

Provide specialty service care coordination to members who are in foster care or pediatric members identified as being adopted. Ensure appropriate services are delivered by specialty providers and ensure continuity of care across services. Responsible for the total care plan, encompassing all services and plans related to beneficiaries. Provide case management complying with Conflict Free Case Management rules.

Primary Duties/Responsibilities

May include, but are not limited to:

• Provide high touch outreach contacts with assigned members and intensive family engagement with the relevant guardians and caregivers
• Wrap around services for family, ensuring they receive support, services and advocacy during adoption or child welfare journey
• Assist members with healthcare needs by ensuring providers and services are working together so that the member’s health is improved.
• Provide health education and coaching to members tailored to issues identified within treatment and service plans.
• Develop the Person-Centered Support Plan (PCSP) and provide choices for members in this process.
• Ensure compliance with the PCSP and assist with any resources needed or barriers to accessing treatment.
• Coordinate with various healthcare providers for diagnostics, ambulatory care, and hospital services.
• Assist members with social determinants of health including access to exercise and healthy food.
• Promote activities focused on the health of a patient and their community, including outreach, quality improvement, and patient panel management.
• Coordinate community-based management of medication therapy
• Participates in staff meetings and clinical conferences.
• Ensures that performance guarantees are met or exceeded.
• Interfaces with external and internal customers to ensure optimal efficiency of service.
• Other duties and responsibilities as assigned.
  
  

Required Skills/Abilities

• Must be able to determine the needed approach, resources, and goals to meet business objectives and member needs.
• Must be able to analyze and translate medical and clinical diagnoses and procedures into designated numerical code.
• Must be able to handle multiple priorities at once.
• Must have excellent written and verbal communication skills.
  
  

Education And Experience

• High school diploma or equivalent required.
• Bachelor’s degree in social science or health-related field (Preferred) or
• 1+ years of experience caring for developmentally or intellectually disabled or behavioral health clients (Preferred.)
• 6+ months of care coordination experience with pediatric members who are in foster care or who are identified as being adopted (Preferred.)
  
  

License/Certification

• Valid driver's license and automobile insurance.
  
  

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.