BC
Manager overseeing medical claim reviews ensuring compliance with standards and implementing process improvements. Engaging with regulatory bodies and maintaining quality performance standards in healthcare.
About the role
- Case Manager working with Mindoula’s members to address health and social needs in Louisiana. The role emphasizes outreach, enrollment, and resource coordination to improve health outcomes.
Responsibilities
- Conduct meaningful outreach, provide education, and drive member enrollment
- In partnership with the member, create a Service Plan to guide engagement based on member diagnoses, results of screenings, as well as care gaps
- Build measurable goals for members to develop skills and/or strategies for managing challenges and triggers to reduce hospital admissions/readmissions and use of the ER, and record outcomes
- Coordinate community resources for each member to support them in achieving their goals as outlined in their Service Plans, created with an emphasis on meeting behavioral health and medical needs, and closing gaps identified in the social determinants of health
- Act as an advocate and liaison between the care team (family, physician, facilities, and/or agencies) and member
- Schedule appointments, build accountability, and follow-up services for members
- Elevate critical incidents and information regarding any quality-of-care concerns
- Report hospital diversions, productivity, and other outcomes weekly
- Prepare and maintain all required records, reports, consents, and members’ diagnostic records
Requirements
- Bachelor’s Degree required in nursing, social work, or other health and human services discipline
- Completion of supervised fieldwork and experience in case management, health, or behavioral health preferred
- Experience as a Certified Case Manager (CCM), Community Health Worker (CHW) or Peer Support Specialist (PSS), or Accredited Case Manager (ACM) preferred
- Knowledge of local resources, social determinants of health, mental health, substance abuse disorders, violence, and social issues is required
Benefits
- Medical, dental, and vision insurance for you and dependents
- 401K
- 11 Holidays and 15 Vacation days
- 4 Wellness days
- Employee Assistance Program and Wellness programs are available to you and dependents
- Design your own workday - we’ve been remote-first from our founding
- You get what you need to excel (MacBook, iPhone, remote technologies)
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