Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollers.
Utilizes critical thinking and judgment to collaborate and inform the case management process, to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members using care management tools and resources.
Conducts comprehensive evaluation of Members using care management tools and information/data review
Coordinates and implements assigned care plan activities and monitors care plan progress
Conducts multidisciplinary review to achieve optimal outcomes
Identifies and escalates quality of care issues through established channels
Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
Provides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choices
Help members actively and knowledgeably participate with their provider in healthcare decision-making
Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Bilingual (Spanish, English) FLUENT speaking and writing
Case management experience required
Candidate will travel approximately 75% of the time within Miami-Dade County seeing members at their homes, in Assisted Living Facilities and Skilled Nursing Facilities