Population Health Case Manager

Summary

Join Mindoula's team in Lexington, KY, as a Case Manager, a key role in delivering the Population Health Program. You will conduct outreach, educate members, and create service plans based on their needs. Responsibilities include coordinating community resources, acting as a liaison between the care team and members, and maintaining accurate records. Success requires strong communication, creativity, and meticulous record-keeping. The position is remote but requires up to 50% local travel. Mindoula is committed to equal employment opportunities.

Requirements

• Above average communication skills and ability to build relationships
• Use creative methods to locate members for engagement and not be easily discouraged
• Complete short-term projects within given deadlines
• Document meticulous member records
• Establish appropriate boundaries with each member that encourages growth and independence
• Become a partner with the clinical team; promote teamwork and unity
• Manage a complex calendar to reach individual and team goals
• Bachelor’s Degree required in nursing, social work, or other health and human services discipline
• Knowledge of local resources, social determinants of health, mental health, substance abuse disorders, violence, and social issues is required
• This position requires up to 50% travel (locally) and, therefore, requires the employee has reliable transportation

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

Preferred Qualifications

• 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

Benefits

Remote/Virtual from home