Job Description

Position Summary: The Care Coordinator Aide (CCA) or Healthcare Navigator will play a crucial role in supporting the Care Coordination team within a health insurance plan by assisting in coordinating care, navigating healthcare services, and helping enrollees understand their health benefits. This position is dedicated to ensuring seamless coordination of healthcare services, focusing on comprehensive care and member advocacy. The CCA will help facilitate communication between enrollees, providers, and care teams to ensure members receive timely and appropriate care.

The role requires a strong commitment to customer service, knowledge of Medicaid benefits and healthcare access, and a proactive approach to handling various tasks in support of care coordination. The CCA will support healthcare initiatives by assisting Care Coordinators in administrative tasks, coordination of services, and ensuring that enrollees have the resources and guidance needed to navigate the healthcare system.

Essential Duties and Responsibilities:

1. Support Care Coordination Team :

• Assist Care Coordinators in managing enrollee care plans and healthcare services.
• Coordinate with providers and other stakeholders to ensure enrollees receive timely, appropriate care.
• Facilitate care planning and ensure enrollee care needs are met through regular follow-up.

1. New Enrollee Outreach:

• Conduct outreach to new enrollees, assisting them in understanding their benefits and care options.
• Complete initial assessments to identify care needs and ensure a smooth onboarding process.

1. Follow-Up and Tracking:

• Conduct follow-ups post discharge with enrollees to ensure they are receiving appropriate care.
• Track and monitor PASRR assessments and other required enrollee evaluations.
• Ensure timely follow-up on Health Risk Assessment (HRA) statuses to ensure proper care coordination.

1. Medication List Completion and Updates:

• Assist with updating and maintaining medication lists for facility residents, ensuring accuracy and completeness.

1. Managed Care Plan and FLMMIS Activities:

• Support managed care plan procedures and activities related to the Florida Medicaid Management Information System (FLMMIS).

1. Enrollee Benefits and Case File Support:

• Help enrollees navigate their benefits, ensuring they understand and can access all covered services.
• Maintain electronic case files for enrollees, ensuring accuracy and compliance with departmental and regulatory requirements.
• Assist in gathering signature forms and completing documentation for care coordination.

1. Community Resource and Provider Network Support:

• Connect enrollees to relevant community resources, ensuring access to needed support.
• Provide support to the Provider Network, including SCA (service coordination agreement) support.

1. Disaster and Emergency Support :

• Assist with disaster outreach, including hurricane preparedness, ensuring enrollees have the resources and support they need during emergencies.

1. Mailing and Outreach Activities:

• Facilitate mailing activities, ensuring timely distribution of enrollee information and resources.
• Manage outreach to enrollees who are difficult to contact, ensuring all attempts to reach them are documented and followed through.

1. Grievance and Appeals Support:

• Provide support to the Grievance and Appeals team by assisting enrollees in navigating complaints, grievances, and appeals processes.

1. Department Support and PHM Systems Management:

• Manage the department worklist, Sharepoint site, calendar activities.
• Assist with case closure activities, ensuring all tasks are completed before case finalization.

1. Ongoing Training and Professional Development:

• Participate in continuous learning opportunities, staying up to date on Medicaid changes, policies, and procedures.
• Assist in training new staff members and contribute to department training sessions

1. Administrative and Supply Support:

• Monitor and order supplies for staff as needed, ensuring the department is well-stocked.
• Assist with special projects, such as coordination of the expanded benefits .

1. Adaptability and Flexibility:

• Adapt to changing department needs and remain flexible in supporting various care coordination tasks.

*This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their management and leadership team.

Skills and Abilities:

1. Self-Motivation and Independence
2. Communication
3. Organizational and Problem-Solving Skills
4. Team Collaboration
5. Project Management
6. Motivational Interviewing and Education
7. Analytical Skills
8. Mathematical Skills
9. Practical Problem-Solving

Work Schedule:

As a continued effort to provide a safe and productive work environment, Community Care Plan is currently following a hybrid work schedule. Staff are able to work from home 3 days a week and will report to the office 2 days a week. *****The company reserves the right to change the work schedules based on the company needs.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity and inclusion.

Qualifications:

Education :

• Minimum of an Associate Degree in Nursing or Social Work is required.
• Additional certifications in healthcare navigation or case management are preferred.

Certifications (Preferred)

• Licensed Practical Nurse (LPN) or Registered Nurse (RN) License
• State Licensure - Must meet the state-specific licensure requirements for social workers
• Healthcare Navigator Certification
• Certified Case Manager (CCM)
• Chronic Care Professional (CCP) Certification
• Certified Professional in Healthcare Quality (CPHQ)
• Disease Management Certification (CDMS)
• Patient Navigator Certification (PNC)
• Medical Assistance (RMA)

EXPERIENCE :

Clinical Experience :

• At least 2 years of experience working in assisting a team managing chronic diseases, complex medical cases, or care coordination, preferably in settings such as hospitals, outpatient clinics, or community health organizations.

Experience in Managed Care/Health Plan Setting:

• At least 2 years of experience working in a managed care, health plan, or insurance environment, specifically in roles related to chronic disease management, case management, or care coordination.

Care Coordination and Case Management:

• Demonstrated experience in assisting members with complex medical needs in navigating the health care system and collaborating with multidisciplinary teams to close gaps in care and improve health outcomes.

Regulatory Knowledge:

• Familiarity with Medicaid, Medicare, or other state and federal healthcare programs, including knowledge of relevant regulations, compliance standards, and quality benchmarks.

Technical Proficiency:

• Proficient in Microsoft Office Suite and other relevant software for documentation and data management.
• Experience with electronic health records (EHR) systems such as EPIC, JIVA, or similar platforms is preferred.

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