Job Title:
Member Care Coordinator
Location:
Albuquerque, New Mexico
Job Type:
Contract
Expected Hours per Week:
40 hours per week
Schedule:
8-5, M-F, Hybrid
Pay Range:
$25 – 28 per hour
Role Overview
This position is responsible for conducting home health assessments, engaging members in their personal health plans, and supporting clinicians within the Medical Management department. The role focuses on member outreach, education, care plan adherence, and non?clinical case support while maintaining strict compliance with HIPAA and corporate policies.
The ideal candidate has experience in care coordination, managed care systems, or clinical support, strong communication skills, and the ability to build trust with members to improve health outcomes.
What You’ll Do
- Conduct home health assessments and complete system updates
- Perform member outreach and follow?up regarding individual health care plans
- Build strong relationships with members to encourage care plan compliance
- Identify issues early and escalate concerns to Case Managers as needed
- Educate members on health care programs using approved scripts and motivational interviewing
- Encourage program participation by scheduling appointments and coordinating services such as transportation
- Generate and send member correspondence manually, electronically, or telephonically
- Conduct routine check?ins to review individual care plan goals and progress
- Maintain productivity and quality standards based on departmental requirements
- Support clinical staff by completing non?clinical case management functions to open, manage, and close cases
- Receive, analyze, research, and respond to member and provider inquiries
- Process incoming information to determine needs and route issues to appropriate internal teams
- Perform accurate data entry to update member and provider information
- Obtain missing or required documentation via phone or written correspondence
- Support claims?related activities, including research and obtaining medical records or letters of medical necessity
- Reopen or initiate cases as needed and refer cases to clinicians for review
- Collaborate with internal departments including Marketing, Provider Affairs, and SSD
- Identify and report system issues to the help desk
- Participate in special projects and maintain ongoing communication with management
Required Qualifications
- Bachelor’s degree in Social Work or Psychology OR
- LVN or LPN with 1+ year of managed care experience OR
- RN OR
- 3+ years of care coordination experience for a state managed or waiver program OR
- 3+ years of managed care systems experience
- Knowledge of medical terminology
- Experience coordinating member medical needs and analyzing member situations
- Strong customer service and member engagement skills
- Proficiency with Microsoft Office and PC?based systems
- Excellent verbal and written communication skills
- Experience developing written correspondence and educating members on medical topics
- Coaching skills, including motivational interviewing
- Current state driver’s license, reliable transportation, and applicable insurance
- Ability and willingness to travel for home health assessments
Compliance & Professional Standards
- Adhere to HIPAA, Diversity Principles, Corporate Integrity, and Compliance Program policies
- Maintain strict confidentiality of company and member information
- Communicate professionally and effectively with members, providers, coworkers, and leadership
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