Bilingual Outreach Lead, Care Manager

Role Overview

• Care Coordination: Manage an assigned caseload of adult and pediatric members
• Conduct comprehensive assessments to determine the physical, emotional, and social needs of members
• Develop individualized care plans based on assessment findings, considering medical history, preferences, and specific needs
• Tailor care plans to individual needs and goals
• Coordinate and facilitate communication between healthcare providers, social workers, therapists, and other members of the care team to ensure a comprehensive and integrated approach to care
• Collaborate with Medical Doctors, Clinical Consultants, Housing Navigators and Leaders to make recommendations tailored to member needs
• Continuously monitor the progress of members and update care plans as needed per policy and compliance requirements
• Ensure prescribed treatments and interventions are being followed and communicate to PCP and specialty care providers any significant changes to member concerns along with any updates on member status
• Provide positive client service experience through multiple support channels including telephonic and in-person; the Enhanced Care Management program is high touch and in-person centered
• Maintain accurate and up-to-date records of assessments, care plans, and interactions with members
• Ensure compliance with relevant regulations and standards
• Complete all required documentation accurately in a timely manner and in accordance with company standards
• Provide leaders with case progress periodically and on a required basis
• Serve as an advocate for patients or clients, helping navigate the healthcare system, understand treatment options, and access the services required
• Provide education to members and their families on health-related topics, treatment options, and self-care strategies
• Identify and connect members with appropriate community resources, support services, and programs to address needs, such as housing assistance, financial aid, or counseling services
• Help plan and coordinate the discharge process for members leaving hospitals or long-term care facilities, ensuring a smooth transition to home or another care setting
• Opportunity to participate in training new employees
• Outreach: Conduct telephonic or in-person outreach efforts to current or prospective members
• Follow established policies to outreach, enroll, and exclude members
• Verify enrollment eligibility for the Enhanced Care Management program
• Complete referrals to the ECM program when necessary
• Partner with healthcare professionals, community, social support services, and other healthcare entities to locate members
• Answer inbound helpline and respond to member inquiries in a timely and professional manner
• Continuously improve knowledge of Company products and services to better assist members
• Utilize and review data sharing sites to collect and share patient health information and ER utilization with relevant care teams to initiate transition of care
• Review and verify the accuracy of member information file to ensure data is up to date and there are no errors
• Perform other duties as assigned or required per departmental policy

Requirements

• Associate degree and minimum 2+ years of healthcare or care coordination experience
• Current and valid Driver’s License
• Proof of auto insurance
• Current BLS certification from the American Heart Association upon start date
• Distraction-free home workspace with a secure internet connection

Benefits

• Make an impact: an organization who cares about its employees, communities, and the future of healthcare
• Inclusivity: be a part of a workplace where you not only belong but also can be the best version of yourself
• Growth: opportunities to develop and grow your career with us
• Community: you are encouraged to have a voice, share your opinions, and have an individual impact on the business
• Paid Time Off: 12 holidays and up to 15 days of accrued PTO to rest and recharge plus additional time for sick, jury duty, bereavement, reproductive loss, and therapy
• Work Life Balance: enjoy flexibility to maximize your well-being and success with our hybrid work model
• Medical, Dental, & Vision Benefits: we cover up to 100% of your premium and 50% of your dependents depending on the plan
• Prioritize your mental health with unlimited therapy sessions funded 100% by Titanium Healthcare
• Flexible Spending, Health Savings & Dependent Care Accounts
• Life/AD&D insurance funded 100% by Titanium Healthcare
• Supplemental Short-Term Disability
• Employee Assistance Programs
• Protect your pet(s) with Pet Insurance
• 401(k) plan