Managed Care Coordinator - Region 5

Managed Care Coordinator

Job Summary The Managed Care Coordinator is responsible for the non-clinical management of members' individual service plans within the scope of the position and in accordance with applicable state laws and contracts. This field-based role conducts telephonic and face-to-face assessments, identifies potential health care and social needs using pre-defined tools, and collaborates with members, families, and interdisciplinary clinical teams to coordinate cost-effective, efficient care.

Key Responsibilities

• Member Assessment & Identification: Conduct telephonic or face-to-face health history and program needs assessments using structured, pre-defined question sets. Identify members with potential clinical needs or high-risk complications and escalate cases to the clinical healthcare management team (role involves non-clinical processes only).
• Service Plan Management & Care Coordination: Manage non-clinical needs for members with chronic illnesses, co-morbidities, or disabilities. Establish short- and long-term care goals in collaboration with members, caregivers, family, natural supports, and physicians.
• Resource Optimization: Identify members who would benefit from expanded services or community resources to ensure efficient, cost-effective utilization.
• Interdisciplinary Collaboration: Coordinate member cases closely with clinical healthcare management and multidisciplinary teams to support holistic care delivery.
• Field Travel: Travel to member homes, worksites, and community locations as necessary to perform in-person assessments and care coordination.
  
  

Qualifications & Requirements

• Education: Bachelor’s degree (BA/BS) required; a major in a healthcare-related field is preferred. (An equivalent combination of education and directly relevant experience will be considered unless restricted by state law/contract).
• Experience: Minimum of 1 year of experience working directly with the specific target population or within related community-based organizations.
• Certifications: For MMP programs, a Community Health Worker (CHW) certification must be obtained within one (1) year of employment.
• Licensure Note: This role is utilized in markets where state law and contracts do not require Managed Care Coordinators to be licensed.
  
  

Position Details & Working Conditions

• Work Location Category: Field-Based (Spends 4–5 days per week in-person with members, providers, or at community sites; Region 3 coverage area).
• Member-Facing Role: Yes (In-person and telephonic contact).
• Schedule: Monday–Friday, 8:00 AM – 5:00 PM (with occasional work required outside standard business hours).
• Care Facility Access: Role does not take place in an on-site clinic/assisted living center and does not involve access to medication.
  
  

Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.

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