Field Care Coordinator - ALTCS - East Valley

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The Field Care Coordinator (Case Manager) will be the primary case manager supporting a caseload of members with low-to-medium complexity medical/behavioral needs, eligible to receive ALTCS or Long Term Care Services. Care coordination activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.

Expect to spend about 50% of your time in the field visiting our members in their homes or in long-term care facilities. You'll need to be flexible, adaptable and, above all, patient in all types of situations.

This is a field-based position covering travel territory in the East Valley including Chandler, Gilbert, Tempe, Queen Creek within Maricopa County, AZ.

Primary Responsibilities:

• Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs • Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines • Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan • Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health • Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission • Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 2+ years of case management experience serving members determined to have a Serious Mental Illness (SMI) • 1+ years of case management experience serving elderly and/or persons with physical or developmental disabilities • 1+ years of experience with MS Office, including Word, Excel, and Outlook • Driver's License • Access to reliable transportation and the ability to travel within assigned territory to meet with members and providers about 50% of the time