Who we are:
Meridian Health Plan is a family-owned, family-operated company of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in six different states (Michigan, Illinois, Iowa, Indiana, Kentucky, and Ohio).
Our employees work hard, play hard, and give back. Meridian employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, weekly Executive Lunches, and volunteer opportunities.
A Day in the Life if a Community Care Coordinator:
This position coordinates care for high risk populations identified by the clinical team leader. This position must work cooperatively with multidisciplinary care teams that may include: the member’s PCP, specialists, social worker/behavioral health specialist and community resource contacts, while functioning with professional autonomy under the supervision of their Manager/Director. This position performs appropriate assessments, organizes, collects, reviews and reports health and social information through member home visits and phone outreach, while demonstrating multicultural sensitivity and effective communication skills with members. This position follows established safety protocols in the community setting, as well as established preventive and disease management programs for health promotion and education, while delivering culturally appropriate information regarding the availability of health and community resources that will reduce barriers to care. This position is field based.
- Serve as the direct personal contact in the community with assigned Meridian Health Plan (MHP) members
- Acts an advocate for the member, assuring they receive the supports and services they desire and are eligible to receive
- Develop and maintain relationships with key individuals in the community and act as an advocate to linkages or referrals to improve health, social, and environmental conditions for MHP members
- Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure member safety.
- Conduct complete, timely and accurate Comprehensive Risk Assessments (face-to-face and telephonically), including current member demographic information and other clinical assessments/reassessments as identified by clinical judgment or Manager/Director.
- Create and update a personalized, member centered plan of care involving the members PCP, family/caregiver, Social Worker/Behavioral Health specialists and other specialists as needed to evaluate the individuals’ needs, goals, and plan of action.
- Assure individualized Plan of Care for each member that addresses all risks identified within the Comprehensive Assessment
- Develops Service Level Plans and then coordinates, monitors and revises as needed to assure that members receive the services as authorized within the scope of the member’s benefit package
- Monitor service provision to assure the members needs are being met and services meet Meridian and state contractual quality standards
- Assist member to achieve goals as indicated within the Plan of Care
- Assemble information concerning member’s clinical background and referral needs, and per referral guidelines provides appropriate clinical information to PCP and specialists.
- Assists members in problem solving potential issues related to the community and in home supports, health care system, such as need for transportation, interpreters, etc.
- Be the system navigator and point of contact for members and families, with members and families having direct access for asking questions and raising concerns.
- Identify and utilize cultural and community resources.
- Ensure referrals are addressed in a timely manner.
- Remind members of scheduled appointments.
- Provides follow up with member/family when member transitions from one setting to another. Completes post hospital discharge follow-up: Medication reconciliation data collection, PCP or specialist follow up appointments.
- Seeks to resolve any concerns about care delivery or providers
- Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
- Must create and maintain strong communication with the members’ integrated care team.
- Must create a relationship with the member working towards their optimal overall health and well-being by facilitating transitions of care for members through individual meetings in person and by phone.
- Closely monitor members’ medical history and any changes through initial screenings and comprehensive assessment of the members needs during their coordination of care.
What you can bring to Meridian:
- Current license (without restriction) to practice as a Registered Nurse in the designated State is required; or
- Must have a BSN, or have BA/BS degree in social science, social work or related field. One year of program experience, which is defined as assessment, provision and/or authorization of formal services for the elderly, may replace one year of college education up to and including 4 years of experience replacing a baccalaureate degree; or
- Be an LPN with one year of program experience, which is defined as assessment, provision and/or authorization of formal services for the elderly
- Ability to possess a valid State of Illinois driver’s license and to travel is required. Any MHP employee who uses a motor vehicle in the course of their duties representing MHP must be compliant with Illinois State Motor Vehicle laws and must follow the policy that pertains to Driver’s License Requirements as a condition of employment.
- Prior experience with population preferred
What Meridian can offer YOU:
Our healthcare benefits include a variety of PPO plans that are effective on the first day of employment for our new full-time team members.
Meridian offers 401k matching is above the national average.
Opportunities for growth are abundant; full-time MHP employees are eligible for tuition reimbursement and all employees have access to a variety of training through Meridian University.
Meridian Health Plan was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.