Population Health & Concierge Care Coordination, Care Coordinator Aide
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Position Summary: The Care Coordinator Aide (CCA) or Healthcare Navigator will play a crucial role in supporting the Care Coordination team within a health insurance plan by assisting in coordinating care, navigating healthcare services, and helping enrollees understand their health benefits. This position is dedicated to ensuring seamless coordination of healthcare services, focusing on comprehensive care and member advocacy. The CCA will help facilitate communication between enrollees, providers, and care teams to ensure members receive timely and appropriate care. The role requires a strong commitment to customer service, knowledge of Medicaid benefits and healthcare access, and a proactive approach to handling various tasks in support of care coordination. The CCA will support healthcare initiatives by assisting Care Coordinators in administrative tasks, coordination of services, and ensuring that enrollees have the resources and guidance needed to navigate the healthcare system.Essential Duties and Responsibilities:* Support Care Coordination Team:* Assist Care Coordinators in managing enrollee care plans and healthcare services.* Coordinate with providers and other stakeholders to ensure enrollees receive timely, appropriate care.* Facilitate care planning and ensure enrollee care needs are met through regular follow-up.* New Enrollee Outreach:* Conduct outreach to new enrollees, assisting them in understanding their benefits and care options.* Complete initial assessments to identify care needs and ensure a smooth onboarding process.* Medicaid and Level of Care (LOC) Redeterminations:* Assist in Medicaid redetermination processes, ensuring enrollees maintain eligibility.* Facilitate LOC redetermination activities with CARES and ensure completion of required forms, such as the 3008 form review.* Follow-Up and Tracking:* Conduct follow-ups post discharge with enrollees to ensure they are receiving appropriate care.* Track and monitor PASRR assessments and other required enrollee evaluations.* Ensure timely follow-up on Health Risk Assessment (HRA) statuses to ensure proper care coordination.* Medication List Completion and Updates:* Assist with updating and maintaining medication lists for facility residents, ensuring accuracy and completeness.* Managed Care Plan and FLMMIS Activities:* Support managed care plan procedures and activities related to the Florida Medicaid Management Information System (FLMMIS).* Handle department fax retrieval and distribution, ensuring efficient workflow processes.* Enrollee Benefits and Case File Support:* Help enrollees navigate their benefits, ensuring they understand and can access all covered services.* Maintain electronic case files for enrollees, ensuring accuracy and compliance with departmental and regulatory requirements.* Assist in gathering signature forms and completing documentation for care coordination.* Community Resource and Provider Network Support:* Connect enrollees to relevant community resources, ensuring access to needed support.* Provide support to the Provider Network, including SCA (service coordination agreement) support.* Disaster and Emergency Support:* Assist with disaster outreach, including hurricane preparedness, ensuring enrollees have the resources and support they need during emergencies.* Mailing and Outreach Activities:* Facilitate mailing activities, ensuring timely distribution of enrollee information and resources.* Manage outreach to enrollees who are difficult to contact, ensuring all attempts to reach them are documented and followed through.* Grievance and Appeals Support:* Provide support to the Grievance and Appeals team by assisting enrollees in navigating complaints, grievances, and appeals processes.* Department Support and Call Queue Management:* Manage the department call queue, ensuring timely and accurate responses to inquiries.* Assist with case closure activities, ensuring all tasks are completed before case finalization.* Ongoing Training and Professional Development:* Participate in continuous learning opportunities, keeping up to date on Medicaid changes, policies, and procedures.* Assist in training new staff members and contribute to department training sessions* Administrative and Supply Support:* Monitor and order supplies for staff as needed, ensuring the department is well-stocked.* Assist with special projects, such as coordination of the expanded benefits .* Adaptability and Flexibility:* Adapt to changing department needs and remain flexible in supporting various care coordination tasks.* This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their management and leadership team.Skills and Abilities:* Self-Motivation and Independence:* Demonstrates the ability to self-motivate and work independently, managing time and resources effectively to complete tasks with minimal supervision.* Communication:* Exceptional oral and written communication skills, with the ability to clearly convey complex information to diverse audiences, including patients, healthcare providers, and team members.* Strong interpersonal communication skills, with the ability to effectively collaborate and build relationships within multidisciplinary teams.* Organizational and Problem-Solving Skills:* Highly organized with excellent problem-solving abilities, capable of managing multiple priorities and tasks in a dynamic healthcare environment.* Skilled in professional interaction and human relations, with the ability to navigate complex patient and provider interactions.* Team Collaboration:* Proficient in processes to build and participate in cross-functional teams, promoting a collaborative approach to care coordination and complex case management.* Project Management:* Ability to follow through on projects or assignments to successful completion, demonstrating decisive judgment and a commitment to quality outcomes.* Motivational Interviewing and Education:* Experience with motivational interviewing techniques and understanding of adult learning styles to engage and educate members in self-management of their conditions.* Analytical Skills:* Strong analytical skills with the ability to read and interpret various documents, including safety rules, operating and maintenance instructions, and procedure manuals.* Ability to write routine reports and correspondence and to present information effectively before groups of customers or employees.* Mathematical Skills:* Competent in basic mathematical skills, including the ability to add, subtract, multiply, and divide in all units of measure. Capable of computing rates, ratios, and percentages, and interpreting bar graphs.* Practical Problem-Solving:* Ability to solve practical problems and address a variety of concrete variables in situations where only limited standardization exists. Able to interpret various instructions furnished in written, oral, diagram, or schedule form.Work Schedule:As a continued effort to provide a safe and productive work environment, Community Care Plan is currently following a hybrid work schedule. Staff are able to work from home 3 days a week and will report to the office 2 days a week. *The company reserves the right to change the work schedules based on the company needs.Physical Demands:The physical demands outlined below are representative of those required for an employee to successfully perform the essential functions of this role. Reasonable accommodations may e made to enable individuals with disabilities to fulfill these essential functions.* Regular Activities: While performing the duties of this job, the employee is regularly required to sit for extended periods, use hands to handle or feel objects, tools, or controls, reach with hands and arms, and communicate verbally to effectively interact with team members and enrollees.* Frequent Activities: The employee is frequently required to stand, walk, and sit, which may involve moving between different areas of the work environment.* Occasional Activities: The employee may occasionally be required to stoop, kneel, crouch, or crawl to perform specific tasks or to access certain areas.* Lifting Requirements: The employee may occasionally need to lift and/or move items weighing up to 15 pounds.Work Environment:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity and inclusion.Education:* High school diploma or equivalent; additional certifications related to healthcare navigation or case management are preferred.Certifications (Preferred)the Preferred certifications focus on assisting individuals in navigating health insurance Benefits, coordinating care, and ensuring compliance with Contract Requirements.Below are the Preferred certifications and qualifications for this role:* Healthcare Navigator Certification* Certified Case Manager (CCM)* Chronic Care Professional (CCP) Certification* Certified Professional in Healthcare Quality (CPHQ)* Disease Management Certification (CDMS)* Licensed Practical Nurse (LPN)* Patient Navigator Certification (PNC)* Medical AssistanceEXPERIENCE:Clinical Experience:* At least 2 years of experience working in assisting a team managing chronic diseases, complex medical cases, or care coordination, preferably in settings such as hospitals, outpatient clinics, or community health organizations.Experience in Managed Care/Health Plan Setting:* At least 2 years of experience working in a managed care, health plan, or insurance environment, specifically in roles related to chronic disease management, case management, or care coordination.Care Coordination and Case Management:* Demonstrated experience in assisting members with complex medical needs in navigating the health care system and collaborating with multidisciplinary teams to close gaps in care and improve health outcomes.Regulatory Knowledge:* Familiarity with Medicaid, Medicare, or other state and federal healthcare programs, including knowledge of relevant regulations, compliance standards, and quality benchmarks.Technical Proficiency:* Proficient in Microsoft Office Suite and other relevant software for documentation and data management.* Experience with electronic health records (EHR) systems such as EPIC, JIVA, or similar platforms is preferred.