Care Coordinator

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary

The Care Coordinator is a member of the Care Management team responsible for engaging members through telephonic or face-to-face outreach, assessing non-clinical and social needs, and coordinating access to healthcare, behavioral health, and community-based services. The Care Coordinator serves as a key resource for members, providers, and internal stakeholders by facilitating care coordination, addressing barriers to care, connecting members to resources, and supporting positive health outcomes.

Using motivational interviewing and member-centered engagement strategies, the Care Coordinator supports members across multiple care management programs and populations, including complex care management, transitional care, maternal health, population health, and behavioral health initiatives. The Care Coordinator collaborates closely with clinical staff, customer care teams, providers, community organizations, state agencies, and contracted vendors to ensure members receive appropriate services and support.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/ Responsibilities

·       Supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate.

Member Engagement & Outreach

·       Conduct outreach, screenings, assessments, and interviews to identify member needs and engage members in care management programs.

·       Utilize motivational interviewing techniques to enhance member engagement and participation in healthcare and care management activities.

·       Educate members regarding benefits, healthcare services, community resources, preventive care, and condition-specific health information.

·       Provide appointment reminders, wellness visit support, and preventive care outreach activities.

·       Complete member satisfaction and case closure activities as assigned.

Care Coordination & Resource Navigation

·       Coordinate access to medical, behavioral health, substance use disorder, and community-based services.

·       Facilitate referrals and connections to providers, vendors, community organizations, and state agencies.

·       Advocate on behalf of members to reduce barriers to care and address social determinants of health, including housing, transportation, food insecurity, education, legal services, and other community support needs.

·       Support member access to medications, medical equipment, healthcare appointments, and other services that promote treatment adherence and improved health outcomes.

·       Collaborate with providers, facilities, community agencies, and interdisciplinary team members to ensure coordinated care and successful transitions between care settings.

·       Maintain current knowledge of community resources and available support services.

Care Management Operations

·       Triage cases, referrals, and member needs to clinical staff, providers, vendors, and internal departments as appropriate.

·       Answer and triage calls from departmental phone lines and shared mailboxes.

·       Support care management programs through outreach, follow-up activities, and operational workflows.

·       Partner with leadership and team members to prioritize work, manage assignments, and support departmental goals.

·       Participate in team meetings, quality improvement initiatives, and workflow enhancement activities.

·       Identify opportunities to improve efficiency, member experience, and departmental processes.

Documentation & Administrative Support

·       Maintain accurate, timely, and complete documentation in care management and medical management systems in accordance with regulatory, contractual, accreditation, and organizational requirements.

·       Prepare reports, monitor assigned metrics, and support departmental data collection activities.

·       Provide administrative support for meetings, projects, audits, and care management initiatives.

·       Perform other duties as assigned.

Qualifications

Education

·       Associate degree in Healthcare, Human Services, Social Work, Psychology, Public Health, or a related field required; or equivalent combination of education and relevant experience.

·       Bachelor's degree in a related field preferred.

Experience

·       Two (2) years of experience in healthcare administration, care coordination, customer service, call center operations, community services, or related healthcare support functions.

·       Experience working with Medicaid populations preferred.

·       Experience with care management, behavioral health, community resource coordination, or healthcare service delivery preferred.

·       Bilingual skills preferred.

Competencies

·       Strong motivational interviewing and member engagement skills.

·       Strong verbal and written communication skills.

·       Excellent customer service and advocacy skills.

·       Ability to work collaboratively with interdisciplinary teams, providers, and community partners.

·       Strong organizational, prioritization, and time management skills.

·       Ability to manage multiple tasks in a fast-paced environment.

·       Proficiency with Microsoft Office applications and care management systems.

·       Knowledge of medical terminology and community resources preferred.

Working Conditions

·       Work may be performed in a remote or community-based work environment.

·       Fast-paced work environment requiring extensive telephone and computer-based communication.

·       Face-to-face visits may occur in member homes, provider offices, hospitals, shelters, community locations, and state agencies.

·       Regular and reliable transportation required.

·       Travel may be required based on member and program needs.

·       Regular and reliable attendance is an essential job function.

Compensation Range 

$ 20.19- $29.33

This range offers an estimate based on the minimum job qualifications.  However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer.  This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.  

Note: This range is based on Boston-area data, and is subject to modification based on geographic location. 

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees.