Job Details

LOCATION: Remote - the is a home-based, virtual position that operates Monday - Friday from 8:30am-5:00pm on (EST). The person in this position must live in North Carolina or within 40 miles of the NC border.

GENERAL STATEMENT OF JOB

The Care Coordinator is responsible for providing proactive intervention and telephonic coordination of care to eligible members to ensure that they receive appropriate screening, assessment, services, and care transitions. Responsibilities include administering screenings and assessments, developing care plans toachieve a member's health goals, and managing discharges/transitions between care settings. Care coordinators possess customer service and active listening skills needed to guide individuals of varying backgrounds towards their goals for whole person health.

Care Coordinators perform telephonic outreach and engagement activities for members who are eligible for Tailored Care Management and also provide care coordination for members who qualify for supportive Social Determinants of Health services.

Note: This position requires access to, and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.

ESSENTIAL JOB FUNCTIONS

Outreach and Engagement:

• Telephonic outreach and engagement for members eligible for plan-based Tailored Care Management (TCM).
• Referring members who opt in to TCM for assignment to a care manager.
• Provide telephonic outreach and administration of Care Needs Screenings to all Vaya Medicaid plan members.
• Provide telephonic outreach and engagement to members eligible for care coordination.
• Conducting the above activities according to applicable rules, regulations, and contract requirements as outlined in Vaya policy and procedure
• Documenting above activities in designated software platforms according to Vaya policy and procedure

Care Coordination and Transition of Care Management:

• Provide telephonic assessment and person-centered care planning for members who opt in to Care Coordination.
• Link members to appropriate care to meet their care plan goals, coordinate member care including locating appropriate providers and services, assisting with appointment reminders, and providing education about relevant health topics and recommended screenings and immunizations
• Manage transitions of care between settings ensuring that members receive appropriate discharge planning and follow up with discharge appointments
• Assessing eligibility for the NC Healthy Opportunities Pilot and linking eligible members to these services using the NCCARE360 software platform
• Conducting above activities in the designated software platform according to Vaya policy and procedure.

Other duties as assigned.

KNOWLEDGE, SKILLS, & ABILITIES

• A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance.
• Exceptional interpersonal skills, effective oral and written communication skills, and the ability to make prompt independent decisions based upon relevant facts
• Problem solving, negotiation, and conflict resolution skills are essential to balance the needs of both internal and external customers.
• The employee must be detail oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish. Work activities quickly change according to mandated changes and changing priorities. The employee must be able to shift focus to meet changing priorities.
• Knowledge of Behavioral Health/I/DD Tailored Plan (Tailored Plan) eligibility and services
• Working understanding of the concepts of whole-person health and health-related resource needs (formerly known as social determinants of health)
• Community integration (Independent living skills; transition and diversion, supportive housing, employment, etc.)
• Health promotion (Common physical comorbidities, self-management, use of IT, care planning, ongoing coordination)
• Person-centered needs assessment and care planning, etc.
• Serving pregnant and postpartum women with SUD or with SUD history
• Thorough knowledge of standard office practices, procedures, equipment, and techniques and have intermediate to advanced proficiency in Microsoft Office products (Word, Excel, Power Point, Outlook, Teams, etc.)

EDUCATION & EXPERIENCE REQUIREMENTS

• Bachelor's Degree in Human Services and at least two (2) years of progressive experience providing similar services to the population served.

OR

• Bachelor's Degree in a field other than Human Services and at least four (4) years of progressive experience providing similar services to the population served.

To meet federal requirements for Care Coordination, the incumbent must be qualified as a Qualified Professional according to 10A NCAC 27G .0104.

Preferred work experience:

• Call Center (inbound/outbound) experience
• Tailored Care Management experience
• Care Coordination experience
• SDoH experience
• Medical Administration or Assessment
• Customer Success
• At least four (4) years of post-degree experience in customer success management, communications, and/or administrative care)

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit

Vaya Health is an equal opportunity employer.