Case Management Coordinator (Bilingual Spanish/English) – Medicaid Long-Term Care

Location: Remote (Work from Home) – Candidates must reside in Mid-Miami, FL within one of the following ZIP codes:
33174, 33144, 33134, 33165, 33175, 33184, 33182, 33172, 33126
Schedule: Monday–Friday, 8:00 AM – 5:00 PM EST
Travel Requirement: 50%–75% local travel throughout the Mid-Miami area for face-to-face member visits in homes, assisted living facilities, and nursing homes.
Training: Remote training via Microsoft Teams for approximately 4–6 weeks.

Position Summary

We are seeking a highly organized, self-motivated, and tech-savvy Case Management Coordinator to join our Case Management team. This role is responsible for assessing, planning, implementing, and coordinating case management services for Medicaid Long-Term Care and Comprehensive Program members. The ideal candidate will effectively manage a caseload of medically complex and supportive care members while promoting improved health outcomes, care coordination, and member independence.
The Case Management Coordinator will conduct telephonic and in-person assessments, develop individualized care plans, coordinate healthcare services, and connect members with appropriate resources to support their overall health and wellness.

Key Responsibilities

• Coordinate case management activities for Medicaid Long-Term Care and Comprehensive Program members.
• Conduct comprehensive member assessments using care management tools and clinical data.
• Develop, implement, and monitor individualized care plans.
• Collaborate with physicians, specialists, community providers, and interdisciplinary teams to ensure optimal member outcomes.
• Coordinate healthcare services, including prior authorizations, provider referrals, medication reviews, and community resource support.
• Perform face-to-face and telephonic member visits as required.
• Identify and escalate quality-of-care concerns through established processes.
• Utilize motivational interviewing and engagement techniques to encourage member participation in care plans and healthy lifestyle changes.
• Educate and empower members to make informed healthcare decisions.
• Maintain accurate documentation and comply with all regulatory, accreditation, and organizational guidelines.
• Monitor member progress and adjust care plans as needed to improve health outcomes.

Required Qualifications

• Fluent bilingual Spanish and English (reading, writing, and speaking required).
• Bachelor's degree required.
• Degree in Social Work, Human Services, Healthcare Administration, Psychology, or a related field preferred.
• Minimum of one (1) year of case management experience required.
• High School Diploma or GED verification required.
• Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook.
• Strong organizational, communication, and critical-thinking skills.
• Ability to multitask and adapt effectively in a fast-paced environment.
• Reliable transportation and ability to travel extensively within the assigned service area.

Preferred Qualifications

• Case Management Certification.
• Long-Term Care experience.
• Managed Care experience.
• Discharge planning experience.
• Experience working with Medicaid populations.
• Knowledge of community resources and healthcare support services.

Additional Information

• This is a fully remote, field-based position.
• Candidates must reside within the designated Mid-Miami ZIP codes listed above.
• Extensive local travel is required for member visits.
• Prior CVS/Aetna experience is not required.
• Nursing candidates are not being considered for this position.