Who we are:
Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.
Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.
A Day in the Life of a Clinical Care Coordinator:
This position is responsible for specific functions within the Care Coordination department. This position oversees the care coordination for designated populations and provides clinical oversight to a team of care coordinators to ensure assessment of member's clinical and psychosocial status, interdisciplinary team approach, and education of members until self- management is achieved.
Ensures that appropriate assessments are performed within program specific timeframe
Participates in QIA activities and adheres to all regulatory guidelines and standards
Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
Discusses challenging cases with Medical Director assigned to team. Provides recommendations to care coordinators
Provides front line direction to care coordination staff and consult with manager as appropriate for input
Identifies cases that require team case conferences with the nurse reviewer, behavioral health, nutrition, pharmacy appropriate managers, and plan physician to develop a care plan that will be entered into MCS
Acts as a liaison with other MHP departments in relation to care coordination issues
Directs member contact of members referred by care coordinator
Performs post inpatient calls on select members assigned to team
Provides for ongoing clinical training and education of all staff based on needs assessments done with each staff member to determine areas where more training is required. Coordinate such training with the Care Coordination Clinical Trainer and Manager
Performs discharge planning on select members assigned to team
Ensures HEDIS is addressed with all members and providers for members assigned to team
Assists team member in preparing for ICT, when applicable, and team meetings
Participates in ICT meetings, when applicable
Assists with problem and goal identification
Reviews members plan of care and critical incidents, when applicable
Facilitates transition of care process for members transitioning from one setting to another by collaborating with both the primary care coordinator, care coordination nurse and external discharge planner
Assists with special projects or departmental process improvement efforts, as needed
Takes supervisor calls and escalate when appropriate
Performs other duties as assigned
What you can bring to Meridian:
Current license (without restriction) to practice as an, LBSW, LMSW, LLMSW, LPC or LLPC in the designated State
A minimum of 1 year case management/disease management experience
Knowledge of managed care
Knowledge of case management processes including tools and techniques for identification, stratification and management of high-risk members
Must possess working knowledge of MDCH regulations
Knowledge of 5 Star ratings
What Meridian can offer you:
Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
Opportunity to work with the industry's leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
Meridian offers 401k matching that is above the national average.
Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor's or Master's degrees.
Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.
Equal Opportunity Employer