The Care Management Coordinator (CMC) utilizes critical thinking and clinical judgment to collaborate and implement the case management process, in order to facilitate appropriate physical and behavioral healthcare outcomes for members by providing advocacy, care coordination, support and education for members through the use of care management tools and resources.

This position is field-based and requires routine regional in-state travel 80-90% of the time; use of personal vehicle is required.  Qualified candidates must have valid KY driver's license, proof of vehicle insurance, and reliable transportation.  Travel to the Louisville office is also anticipated for meetings and training.

 
Responsibilities include: 

• Evaluation of Members:

  • Through the use of care management tools and information/data review, conducts comprehensive assessment of member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs, including their legal, educational and biopsychosocial needs by evaluating member’s benefit plan and available internal and external resources. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.

  • Coordinates and implements assigned care plan activities and monitors/updates care plan to reflect progress that supports the optimal member health, wellness and compliance with juvenile justice system guidelines.

  • Collaborates with partners from the state and behavioral health systems to ensure that the member understand their health care needs.

• Enhancement of Medical Appropriateness and Quality of Care:

  • Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.

  • Identifies and escalates quality of care issues through established channels.

  • Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.

  • Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health and wellbeing.

  • Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

  • Helps member actively and knowledgably participate with their provider in healthcare decision-making.

  • Monitoring, Evaluation and Documentation of Care

  • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

• Qualified candidates must reside in or adjacent to the following counties: Breckinridge, Grayson, Meade, Hardin, Larue, Bullitt, Nelson, Marion, Washington, Spencer, Anderson, Woodford, Shelby, Franklin, Henry, Oldham, and Trimble.

• 2 years’ experience in behavioral health, social services, or human services field. 

• 1+ year(s) of experience with Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations

• 1 year experience with MS Office Suite applications, including Word and Excel. 

• Must have reliable transportation and be willing and able to travel 80-90% of the time to meet members face to face in Salt River Trail Service region (Breckinridge, Grayson, Meade, Hardin, Larue, Bullitt, Nelson, Marion, Washington, Spencer, Anderson, Woodford, Shelby, Franklin, Henry, Oldham, Trimble). Mileage will be reimbursed per company policy.

• Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required, as we are serving the needs of children and families that may require working after school, after work, etc.