Community Well Care Coordinator

Job DescriptionMUST LIVE IN INDIANAThe Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.Primary Responsibilities:Selects, manages, develops, mentors and supports staff in designated department or regionDevelops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for resultsIn order to meet the unique needs of our members, have an intimate understanding of the contractual requirementsIdentify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirementsEnsures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherenceAssess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of careIdentify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive servicesCommunicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all membersAdvocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care teamParticipates in training and coaching of direct reports as neededConducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationshipCollaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholdersRequired Qualifications:Resident of IndianaBSN or BSW with equivalent experienceRegistered Nurse with an unrestricted License in IndianaExperience working within the community health setting in a health care roleExperience or knowledge of Indiana Medicaid, Medicare, Long term careExperience coaching or mentoring staffIntermediate level of experience with Microsoft Word, with the ability to navigate a Windows environmentPreferred Qualifications:3+ year of case management leadership experience within a healthcare industryBackground in managed careCase Management experienceCertified Case Manager (CCM)Experience / exposure with members receiving long term social supportsExperience in utilization review, concurrent review and/or risk managementCompany DescriptionProfessional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.Professional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.