Care Coordinator DSNP

The Care Coordinator provides administrative and coordination support to the interdisciplinary Care Team (RN and SW). This role partners directly with members, members’ families and/or advocates, providers, and community organizations to help ensure members receive the services, equipment, and supplies needed to support quality of life and progress toward member-identified goals.

The Care Coordinator supports key program activities including welcome calls and assessment completion, development and implementation of the Individualized Care Plan (ICP), and proactive outreach to address barriers to care. The Care Coordinator also educates members and caregivers on plan benefits, helps connect members to appropriate social and health supports, and follows up on an ongoing basis.

• →Welcome and orient new members to the Belong Health DSNP program.

• →Conduct outreach and complete assessments (e.g., Health Risk Assessments and Social Determinants of Health screenings).

• →Support the Care Team in developing and updating each member’s Individualized Care Plan (ICP).

• →Coordinate access to services and resources, including medical and social services, supplies, durable medical equipment (DME), and medications.

• →Facilitate and monitor implementation of the member’s care plan in collaboration with the Interdisciplinary Care Team.

• →Support documentation processes, including preparation for and follow-up from interdisciplinary care team meetings.

• →Identify issues and independently resolve non-clinical questions and complaints; escalate clinical concerns to the appropriate team member or department.

• →Partner with members, providers, and internal staff to identify and address service, satisfaction, and retention opportunities.

• →Educate potential members and community representatives on plan features, benefits, and admission requirements.

• →Support compliance with clinical quality measures, standards, and documentation expectations.

• →Promote a culture of accountability and service excellence, ensuring timely and satisfactory resolution of complex, specialized, and non-routine member issues.

• →This role does not have supervisory responsibilities.

• 2+ years of experience in care coordination, customer service, healthcare, a community-based organization, or a social services environment.
• Experience in a managed care or HMO setting strongly preferred.
• Understanding of the needs and dynamics of older adults and populations experiencing disadvantage and/or disengagement.
• Strong problem-solving, trend identification, and analytical skills.
• Demonstrated commitment to high ethical standards, including protecting member privacy and Belong data and using discretion when handling confidential information.
• Excellent verbal and written communication skills.
• Proficiency with common PC platforms and applications.
• Knowledge of managed care products, benefits, policies, and procedures.
• Strong active listening skills and the ability to assess issues and take appropriate action.
• Strong organizational skills, follow-through, and attention to detail.
• Self-directed and able to work independently.
• Bilingual (Spanish) required.

• Working knowledge of Medicare and Medicaid programs.
• Experience with regulatory requirements and reporting.
• Knowledge of managed care and/or member services.
• Knowledge of community services and resources for older adults and individuals with disabilities.

• Bachelor’s degree in social or health sciences.
• Familiarity with coordinated care models.
• Strong understanding of healthcare products and services.

• Primarily office-based work; sitting for extended periods.
• Comfortable with technology and able to set up and troubleshoot basic remote-work equipment.
• Ability to work independently and remain flexible in a fast-paced startup environment.
• Must have reliable internet.

• Occasional travel required.

$25-$32 per hour

Belong Health is an equal opportunity employer. We are committed to creating an inclusive environment for all employees and applicants and do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.