Case Management Coordinator

About us:

Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued.

** Bilingual in English/Creole or Spanish/Creole is Required **

Position is fully onsite Monday-Friday.

Position Summary:

Case Management Care Coordinators play a crucial role in helping members manage their health by acting as a liaison between the health plan’s Case Management Department and the member’s healthcare providers. They perform their duties as an extension of the case management team, ensuring that the components identified as part of the member’s care are addressed and arranged. The Care Coordinators provide support by reaching out to members and ensuring their needs are met. Additionally, the Care Coordinator gathers key information that enables other members of the department, as well as those in other departments, to deliver exceptional customer care through attention to detail, empathetic communication, and necessary follow-up for optimal healthcare experiences. This role requires flexibility, quick thinking, and a caring disposition.

Essential Duties and Responsibilities:

• Performs member screenings through the completion of health risk assessments.
• Completes interventions based on the member’s individualized care plan.
• Schedules appointments to support care plan goals.
• Communicates professionally with nurses and physicians, both internal and external to the organization.
• Handles inbound calls and answers member inquiries.
• Connects with members via phone and other communication methods.
• Coordinates with community resources to support interventions outlined in the member’s individualized care plan.
• Documents information accurately within the member’s electronic record.
• Assists the case management team with supporting and following up on interventions and actions.
• Ensures compliance with all regulatory requirements, including HIPAA, OSHA, and other federal, state, and local regulations.
• Assists with data collection.
• Maintains a polite and professional demeanor at all times.
• Upholds patient confidentiality at all times.
• Works effectively in a high-paced and demanding environment.
• Demonstrates the ability to multi-task and prioritize effectively.
• Assists with the training of new staff members.
• Performs other duties and projects as assigned.

Qualifications & Education:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below represent the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• High School Diploma and a minimum of two (2) years of experience in a healthcare-related customer service position, or an equivalent combination of education and experience.
• Experience in Medicare and managed care insurance is preferred.
• Knowledge of CMS guidelines is preferred.
• Excellent computer skills are required, including proficiency in Microsoft Office.
• Strong decision-making and organizational skills.
• Excellent listening, interpersonal, verbal, and written communication skills with individuals at all levels of the organization.
• Must be able to perform duties with minimal supervision.
• Willingness and ability to function independently as well as part of a team.
• Working knowledge of medical terminology.
• Fluency in both Creole and English is required.

Performance Measurements:

• Duties accomplished at the end of the day/month.
• Attendance/punctuality.
• Compliance with Company regulations.
• Safety and Security.
• Quality of work.

What set us apart:

Join Solis Health Plans as a Case Management Care Coordinator and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!