Job Description
Job Description
We are seeking an MMA Care Manager to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The MMA Care Manager plays a critical role in coordinating and managing comprehensive care plans for members enrolled in Managed Medical Assistance (MMA) programs. This position focuses on improving member outcomes by assessing individual health needs, facilitating access to appropriate healthcare services, and ensuring adherence to treatment protocols. The Care Manager acts as a liaison between member, healthcare providers, and insurance entities to optimize care delivery and resource utilization. By monitoring member progress and addressing barriers to care, the role contributes to enhanced quality of life and reduced hospital readmissions. Ultimately, the MMA Care Manager supports the organization's mission to provide high-quality, member-centered care within the Medicare Advantage framework.
Minimum Qualifications:
- Bachelor’s degree in Nursing, Social Work, Public Health, or a related healthcare field.
- Current and valid professional licensure or certification relevant to care management (e.g., RN, LCSW).
- Minimum of 3 years’ experience in case management, care coordination, or a related healthcare role.
- Strong knowledge of Medicare Advantage programs, healthcare regulations, and care management best practices.
- Proficiency in electronic health records (EHR) systems and care management software.
- Relevant experience may substitute for the educational requirement on a year-for-year basis.
Preferred Qualifications:
- Master’s degree in Nursing, Social Work, Public Health, or a related healthcare field.
- Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification.
- Experience working specifically with Medicare Advantage populations.
- Advanced degree in healthcare administration, nursing, or social work.
- Familiarity with population health management and quality improvement methodologies.
- Bilingual abilities to effectively communicate with diverse member populations.
Responsibilities:
- Conduct thorough assessments of members’ health status, medical history, and social determinants of health to develop personalized care plans.
- Coordinate with physicians, specialists, and other healthcare professionals to ensure timely and effective delivery of medical services.
- Monitor member adherence to prescribed treatments and medications, providing education and support to encourage compliance.
- Identify and address potential gaps in care, including arranging for additional services such as home health, rehabilitation, or community resources.
- Maintain detailed documentation of care plans, member interactions, and outcomes in compliance with regulatory and organizational standards.