Sentara Health Plans Community Care is hiring a Care Coordinator. This is a remote position however traveling to Nursing Facilities and Members Home is required in Richmond, VA and its surroundings. The Care Coordinator performs a variety of casework duties and provides case management services to patients, families, and designated caregivers. Must develop, participate and monitor multidisciplinary collaboration of services to patients where appropriate. Assist adult patients and their families with personal and environmental difficulties associated with medical condition up to and including at time of terminal illnesses. Key Responsibilities: Develop and implement individualized care plans for members to address their physical, behavioral, social, and long-term care needs. Perform face-to-face clinical assessments to identify, evaluate, and manage members’ needs. Coordinate care for high-risk members, including those with chronic conditions, co-morbidities, or disabilities. Manage care to ensure cost-effective and efficient utilization of health benefits, including conducting gap-in-care management for quality programs. Facilitate authorizations, referrals, and care plan implementation within benefits and coverage structures. Work closely with Medical Directors, Physician Advisors, and Interdisciplinary Teams to present and discuss case management treatment plans. Ensure compliance with regulatory, accrediting, and company policies and procedures. Assist with problem-solving related to provider, claims, or service issues as needed. Education: Must possess a degree in Health & Human Services or one of the related fields listed, from accredited U.S. schools or reviewed individually if obtained outside the U.S. Experience: 1 year of long-term care required, HealthPlan and Medicaid preferred. Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs. Excellent communication skills, both oral and written, as well as strong problem-solving and analytical skills. Ability to work independently and collaboratively in a remote, fast-paced environment.
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