Care Coordinator Case Manager
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Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 62400 - 90750
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is hiring two Care Coordinators to work as part of an interdisciplinary care team providing care management for health plan members with medical behavioral and social needs including Severe and Persistent Mental Illness (SPMI). The Care Coordinator serves as the Interdisciplinary Care Team Lead for members with low to moderate complexities and acts as a key partner in navigating Mass General Brigham Health Plan MassHealth and Medicare services.As an expert on the interdisciplinary team the Care Coordinator conducts assessments develops member-centered care plans coordinates care provides health education and collaborates with providers to ensure comprehensive support. The Care Coordinator engages with Community-Based Organizations to support social engagement recovery Social Determinants of Health wellness and independent living.
This position requires a hybrid work model including practice-based remote work and in-person home and community visits to members when needed. The member population will include residents of Essex Middlesex Suffolk Norfolk Plymouth Bristol Dukes and Nantucket counties.
This positions responsibilities and caseload may be adjusted based on enrollment trends.
Collaborate with interdisciplinary care teamsincluding primary care providers specialists LTSC and GSSCto support program enhancements process improvements and comprehensive care coordination.
Participate actively in interdisciplinary care team meetings and establish consistent communication and reporting with providers and enrollees to review status progress and address challenging situations.
Develop update and implement individualized enrollee-centered care plans in partnership with enrollees and the care team incorporating self-care shared decision-making and behavioral health considerations.
Conduct outreach assessments and home visits via telephonic electronic or in-person methods to evaluate clinical status identify needs and provide ongoing community-based care management or referrals as appropriate.
Monitor enrollees clinical status identify early signs of deterioration and intervene proactively to prevent unnecessary hospitalizations; act as clinical escalation point for urgent issues providing triage and care coordination.
Provide enrollee and family health education coaching and routine engagement tailored to individual needs facilitating access to providers and supportive services.
Utilize electronic medical record systems to accurately document monitor and evaluate interventions and care plans in compliance with DSNP regulations and organizational policies.
Serve as a clinical resource and lead interdisciplinary care team member for assigned enrollees supporting compliance initiatives quality assurance and collaboration with care management leadership.
Perform additional duties as assigned by supervisors to support the overall goals of care management and enrollee well-being.
Qualifications
- Bachelors Degree Required
- Valid Drivers License and reliable transportationrequired
- Minimum of 1-2 years of direct clinical (community case management) experience
- Experience with Dual Eligible Populations (Medicare and Medicaid) highly preferred
- NCQA knowledge preferred
- Competency in working with multiple health care computer platforms (e.g. EPIC)
- Experience working with individuals with complex medical behavioral and social needspreferred
Knowledge Skills and Abilities
- Exceptional communication and interpersonal skills to effectively engage with enrollees and interdisciplinary teams
- Critical thinking and problem-solving skills. Demonstrates autonomy in decision making
- Strong organizational skills with an ability to manage routine work triage and reset priorities as needed
- Interpersonal skills and ability to work effectively with providers and their staff to develop rapport build trust and promote Population Health initiatives. Excellent oral written and telephonic skills and abilities
- Competency in working with multiple health care computer platforms
- Ability to work effectively in a complex fast paced medical environment and multiple practice locations
- Ability to work independently while contributing to a collaborative team environment
- Knowledge of healthcare and community services to assist enrollees effectively
- Must be comfortable with change have the ability to adapt and pivot as part of continuous process improvement activities
Additional Job Details (if applicable)
Working Model Required
- This is a full-time position with a schedule of Monday through Friday 8:30 AM-5:00 PM EDT
- This is a hybrid schedule which includes practice-based work remote work and in-person home and community visits (these days will vary weekly and these visits may increase as the program launches)
- Must be local ideally in Eastern MA with the ability to travel to the community.
- This role offers autonomy to build own schedule to accommodate members needs.
- Remote working days require stable quiet secure compliant working station and access to Teams Video via MGB equipment
Our goal will be to geographically align employees this depends on residence and can vary based on business needs member enrollment and team staffing.
Employee must accommodate the hybrid work model including practice-based work remote work and in-person home and community visits with members.
The member population will reside primarily in Essex Middlesex Suffolk Norfolk Plymouth Bristol Dukes and Nantucket counties. The responsibilities and caseload may be adjusted based on enrollment trends.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$62400.00 - $90750.40/AnnualGrade
6EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Manager
Key Skills
- Senior Care
- Hoyer Lift
- Medical office experience
- Dementia Care
- Home Care
- Nursing
- Alzheimers Care
- Administrative Experience
- Meal Preparation
- Medication Administration
- Memory Care
- Tube Feeding
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
