Member Care Coordinator

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General Information

Job Posting ID 6732515 Creation Date May 21, 2019
Employer Posting No --- Closing Date Jun 20, 2019
Job Site Address WACO, Texas 76712 Employer Type Private Sector
Openings 1

Job Description

BASIC FUNCTION:
This position is responsible for performing medical management of pediatric member cases with chronic care and special needs. The position handles the evaluation of care plans designed to optimize the health care of the member. The position is responsible for needs assessments, service plan development, service authorization activities, and implementation and monitoring of individualized service plans. Perform telephonic clinical assessments. Work within an interdisciplinary team to achieve specific goals for the member.

JOB REQUIREMENTS:
*Bachelor degree in Social Work or a Licensed Vocation Nurse (LVN).
*3 years clinical practice experience.
*Experience with service coordination related to health care.
*Knowledge of clinical utilization management/case management activities and standardized criteria set.
*Knowledge of managed care and insurance industry.
*Verbal and written communication skills; analytical skills; sound clinical judgment.
*PC proficiency to include retrieving and entering data into databases.

PREFERRED JOB REQUIREMENTS:
*1 year health insurance/managed care experience.
*Experience with pediatric special needs population.
*Familiarity of Medicaid waivers and Long Term supports.
*Working toward CM certification.
*Experience managing medical management/clinical cases.
*Experience in Disease Management. *Knowledge of Medical Management policies and procedures.
*Familiarity with medical guidelines (M&R, Interqual, etc.).
*Experience with Texas Medicaid programs.
*Bilingual, English/Spanish, a plus.
*Experience with Microsoft Office applications. lity and willingness to travel
Supervisory Experience Required No
Shift Days (First) Duration Regular
Workweek Full Time
Veterans Only No
Federal Contractor No
Eagle Ford Shale Job No
Is this job related to Hurricane Harvey Clean-up/Restoration? No

Job Requirements

Occupation Medical and Public Health Social Workers
Minimum Experience and Education  0 yrs   6 mos and Associates Degree

- OR -

Occupation Licensed Practical and Licensed Vocational Nurses
Minimum Experience and Education  0 yrs   6 mos and Associates Degree


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Job Title Member Care Coordinator
The employer did not provide an internal job posting number. Please locate this number on their web site and enter it here: Job Posting Number.
State Agency Name HEALTH CARE SERVICE CORP - WACO
Job Closing Date Jun 20, 2019
Open Until Filled No

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