Special Needs Coordinator

About the position Responsibilities • Coordinate care for highly complex members as part of an inter-disciplinary care team approach • Consult and collaborate with local health departments, primary care providers, Federally Qualified Health Centers (FQHCs), social service agencies, and specialty care services to address member complex care needs • Manage referrals to the REM (Rare and Expensive Medical special needs care management) program, including outreach, education, and coordination of member transfer • Serve as a liaison with the MDH REM office • Ensure appropriate re-direct for members to in-network specialty services, working closely with the Prior Authorization team • Act as a Housing coordinator, requiring understanding of county-based resources • Educate Local Health Departments and Community Advisory Committee attendees about Plan programs and services • Represent Special Needs Members at Plan's Quarterly Consumer Advisory Board Requirements • Current unrestricted nursing license (e.g., LPN, LVN) OR Bachelor's level Social Worker (licensed or non-licensed) with work experience in a health care setting • 3+ years of experience in a clinical or managed care setting • Experience with care coordination or case management • Experience with arranging community resources • Experience providing clinical care to low-income populations • Understanding of Medicaid member needs and benefits • Computer/typing proficiency to enter/retrieve data in electronic clinical records and documentation systems; experience with email, internet research, use of online calendars and other software applications • Proficient with Excel to create and pull reports Nice-to-haves • 5+ years of experience in a clinical or managed care setting • Experience and comfortability collaborating with providers and State partners • Experience with EMR [Electronic Medical Records] and care management platforms including the State Health Information Exchange [CRISP] • Proven ability to think creatively and work comfortably within a hands-on, fast-paced, high-demand environment • Proven ability to work with diverse care teams in a variety of settings • Proven ability to exhibit independent clinical judgment, but the ability to consult and engage with other team members for improved patient outcomes • Proven excellent administrative, organizational and verbal skills • Proven effective time management and prioritization skills for competing demands • Proven comfort with ambiguity, willingness to adjust as demands change and evolve Benefits • Flexible remote work options • Opportunities for professional development • Recognition for performance • Supportive work environment that encourages growth Apply tot his job Apply To this Job