Job Summary:
Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
Must reside in the following counties:
Region A: Escambia, Santa Rosa, Washington, Gadsden, Leon, Bay, Okaloosa, Walton, Wakulla, Jackson, Jefferson, Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton, Washington
Region B: Duval, Hernando, Lake, Marion, Volusia, Alachua, Columbia, St. Johns, Flagler, Citrus, Suwannee, Alachua, Baker, Bradford, Citrus, Clay, Columbia, Dizie, Duval, Flagler, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Nassau, Putnam, St John's, Sumter, Suwannee, Union, Volusia
Region C: Pasco, Pinellas
Region D: Hardee, Highlands, Hilssborough, Manatee, Polk - but highest volumes to be in Hillsborough, Manatee, and Polk
Region E: Seminole, Orange, Osceola, Brevard
Region F: Charlotte, Collier, Desoto, Glades, Hendry, lee, Sarasota) - but highest volumes to be in Collier, Lee, and Hendry
Region G: Indian River, Martin, Okeechobee, Palm Beach, and St Lucie )- but highest volumes in Palm Beach, St Lucie, Indian River, and Martin
Region H: Broward
Region I: Miami-Dade, Monroe
Essential Job Duties
- Completes assessments of members per regulated timelines and determines who may qualify for care coordination/care management based on triggers identified in assessments.
- Develops and implements care plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals.
- Conducts telephonic, face-to-face or home visits as required.
- Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
- Maintains ongoing member caseload for regular outreach and management.
- Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care.
- Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration.
- Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
- Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
- Collaborates with licensed care managers/leadership as needed or required.
- 25- 40% estimated local travel may be required (based upon state/contractual requirements).
