• Job Description

  Req#: 26-00560
  
  Job Profile Summary
  
  Position Purpose:
  Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.
  
  Education/Experience:
  Requires a Bachelor’s degree and 2 – 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure.
  
  Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
  
  License/Certification:
  Current state’s clinical license preferred
  For Illinois YouthCare Plan only: Education/Experience: Bachelor's degree in Social Work, Nursing, Health Behavioral Science or equivalent experience. 2+ years of experience working within a social service agency and/or advocacy environment. Must reside in Illinois.
  For Illinois YouthCare Plan Foster Care Liaison Roles only: Will be stationed on-site and hosted by DCFS Regional Offices throughout the State to provide administrative coordination with DCFS staff and stakeholders. Will be available during regular work hours to communicate with and to provide education and training to DCFS staff and stakeholders regarding managed care, and to engage in immediate problem resolution with Contractor's administrative staff. Will ensure that issues or barriers reported to a liaison must be addressed and the resolution communicated to appropriate DCFS staff or stakeholder.
  
  For Health Net Federal Services only: Licensed Bachelor's or Master's Prepared Social Worker; LSW, LCSW, LICSW, or LMSW required
  
  For Nevada SilverSummit (Medicaid) Healthplan: Licensed Bachelor's or Master's Prepared Social Worker: LSW or LMSW required.
  
  For Mississippi Magnolia Health plan: Bachelor’s or Master’s degree in a healthcare related field (social work, sociology, psychology, public health) and 2 – 4 years of related experience; LSW,LMSW preferred.
  
  For CMS Florida licensed practical nurse with a minimum of four years of pediatric experience, or a Master’s degree in social work with a minimum of one year of related professional pediatric care experience. May require up to 80% local travel. required
  
  Responsibilities:
  Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome
  
  Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care
  
  Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
  
  Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner
  
  May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
  
  Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
  
  May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate
  
  May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
  
  Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
  Performs other duties as assigned.
  
  Complies with all policies and standards.
  
  EEO:
  
  “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
  
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  Story Behind the Need – Business Group & Key Projects
  Health plan or business unit Team culture Surrounding team & key projects Purpose of this team Reason for the request Motivators for this need Any additional upcoming hiring needs?	Superior HealthPlan Inbound Member/Provider Call Center STAR Kids Service Coordination hotline - taking calls all day. To answer calls to help members with LTSS Service Coordination, to help providers only with LTSS specific authorization inquiries. This is to cover the SCs who are out in LOA, FMLA and the openings we have open. Self-starters and self-sufficient following work processes and supporting guides, eager to learn and retain information, great customer service with patience and able to educate callers, able to use Excel, OneNote, Teams, and able to respond quickly via Teams to peers and leaders.
  Typical Day in the Role
  Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description	Take calls all day in a remote call center, OT will be based on business needs Inbound call center, assist and educate individuals/legally authorized representatives in the STAR Kids Medicaid program on LTSS benefits and services such as MDCP, PCS, DAHS, Respite, (LTSS list not all inclusive) and DME requests. Remote call center, engagement via Teams
  Compelling Story & Candidate Value Proposition
  What makes this role interesting? Points about team culture Competitive market comparison Unique selling points Value added or experience gained	Each day they will interact with different members/legally authorized representatives and providers, assisting with their LTSS needs or authorizations. The team consists of 11 dedicated SCs to STAR Kids, who have also cross trained to handle STAR+PLUS calls. Each member case is unique. 1. Specialized Knowledge in Medicaid Managed Care Staff gain deep familiarity with Texas Medicaid programs, especially STAR Kids, which serves children and young adults with disabilities. They learn about LTSS (Long-Term Services and Supports), service coordination, and waiver programs—knowledge that’s highly transferable within healthcare and social services. 2. Enhanced Communication & Empathy Skills STAR Kids members and families often face complex medical and social challenges. Supporting them helps staff develop: Empathetic listening Clear and compassionate communication Crisis de-escalation and problem-solving 3. Exposure to Care Coordination Processes Staff often collaborate with service coordinators, providers, and other stakeholders. They gain insight into interdisciplinary care planning, which is valuable for roles in case management, social work, or clinical support. 4. Regulatory & Compliance Awareness STAR Kids is governed by strict state and federal guidelines. Staff become familiar with HIPAA, Medicaid regulations, and quality assurance protocols, which are essential in any healthcare setting. 5. Career Development Opportunities The experience can serve as a stepping stone to roles in: Care management Utilization review Member advocacy Training and quality assurance 6. Cultural Competency & Diversity Training STAR Kids serves a diverse population, including non-English-speaking families and those with varying cultural backgrounds. Staff build cultural sensitivity and inclusive communication skills, which are increasingly valued in all industries.
  Candidate Requirements
  Education/Certification	High Schook Diploma	Preferred BUT NOT Required: BA in Social Work or Healthcare Mgmt, LVN, CNA, CMA, RT, Pharmacy Tech
  Licensure	n/a	Preferred:
  Years of experience required Disqualifiers Best vs. average Performance indicators	Years Experience: 4 years experience, call center, Medicaid and worked with MCO Insurance. Must haves: good attendance, call center background; worked with MCO insurance Nice to haves: background in Service Coordination, and call center experience. Disqualifiers: no call center experience Performance indicators: Software Skills: Will be using various software on the job: Microsoft Office Suite, Avaya, Zoom, Skype
  
  

• About the company

  Mindlance is one of the largest diversity-owned staffing firms in the US . As a recruitment centric talent acquisition company, Mindlance provides Technology, Engineering, Digital / Creative / Marketing, Clinical Research, Scientific, Finance, Professional and Payroll Management staffing services to Global 1000 companies across the US, Canada and India.

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