
Field Care Coordinator - Las Cruces, NM Remote
- Las Cruces, NM
- $28.27-50.48 per hour
- Permanent
- Full-time
- Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs
- Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
- Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan
- Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
- Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
- Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team
- Create a positive experience and relationship with the member
- Practice cultural sensitivity and cultural competence in daily care
- Learn and listen to member needs and barriers to help promote self advocating
- Collaborating with clinical team of social aspects that might impact treatment plan
- Proactively engage the member to manage their own health and healthcare
- As needed, help the member engage with mental health and substance use treatment
- Provide member education and health literacy on community resources and benefits to encourage self sufficiency
- Support member to engage in work or volunteer activities, if desired, and develop stronger social supports through deeper connections with friends, family, and their community
- Partner with care team (community, providers, internal staff)
- Knowledge and continued learning of community cultures and values
- Conduct Comprehensive Needs Assessment (CNA)
- Must meet one of the following:
- Bachelor's degree OR 2+ years of relevant health care experience
- Current, unrestricted independent licensure as a Registered Nurse OR a Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Professional Clinical Mental Health Counselor, or Licensed Mental Health Counselor (LMHC) with 3 years of clinical experience
- LPN with 3+ years of clinical experience
- 2-year degree or higher with 3+ years of clinical experience
- 5+ years of relevant experience, including 3 years of clinical experience
- 4+ years of experience in a clinical environment (including 1+ years of experience as a Care Coordinator)
- 1+ years of experience with MS Office, including Word, Excel, and Outlook
- Driver's license and reliable transportation and the ability to travel up to 50% of the time within assigned territory to meet with members and providers
- Must have a designated workspace inside the home with access to high - speed internet availability
- Reside in or within commutable driving distance to Las Cruces, NM or within commutable driving distance
- CCM certification
- 1+ years of community case management experience coordinating care for individuals with complex needs
- Background in Managed Care
- Experience working in team-based care
- Reside in New Mexico