Autism Family Support Care Coordinator Monday-Friday 8a-5p (occasional evenings or weekends)

Job Summary:   The Autism Family Support Care Coordinator provides Anthem-affiliated, home- and community-based care coordination services to individuals with autism and their families. Using a member-centered, trauma-informed, and whole-person approach, this role partners with members, caregivers, providers, and Anthem care management teams to assess needs, address social determinants of health (SDOH), and coordinate access to medical, behavioral, educational, and community-based services. The Care Coordinator conducts in-home assessments, develops and monitors individualized care plans, supports care transitions, and ensures timely documentation and compliance with Anthem, Medicaid, and organizational care coordination standards.

  Key Responsibilities:

• Conduct comprehensive in-home and community-based assessments to identify member strengths, needs, risks, goals, and barriers to care.
• Build trusting, respectful relationships with members and caregivers using a family-centered and trauma-informed approach.
• Develop, implement, and regularly update individualized care plans in collaboration with members, caregivers, providers, and Anthem care managers.
• Coordinate services across physical health, behavioral health, education systems, Medicaid waivers, and community resources to ensure continuity of care.
• Collaborate with Anthem care managers and managed care partners to align care plans, share updates within allowable guidelines, and prevent duplication of services.
• Complete required outreach, assessments, and care plan updates in accordance with Anthem timelines, quality measures, and contractual requirements.
• Support care transitions, including hospital discharges, changes in service needs, and transitions across life stages.
• Identify and address social determinants of health impacting the member and family, including housing, food insecurity, transportation, education, and caregiver stress.
• Advocate for member needs within service systems while empowering caregivers through education, coaching, and resource navigation.
• Support families in understanding benefits, eligibility requirements, and available Anthem-covered and community-based services.
• Conduct home visits in accordance with organizational and Anthem-aligned safety protocols.
• Maintain situational awareness and assess environmental or safety risks during home and community visits.
• Appropriately escalate concerns related to safety, risk, or unmet needs in collaboration with supervisors and care management partners.
• Accurately and timely document all assessments, home visits, outreach activities, care plans, and outcomes in Anthem-approved care management systems.
• Ensure compliance with Anthem, Medicaid, HIPAA, and organizational policies, including confidentiality and ethical standards.
• Participate in Anthem audits, quality reviews, performance monitoring, and data reporting activities.
• Meet established productivity, timeliness, and quality benchmarks.
• Collaborate with interdisciplinary teams, community providers, schools, and service partners to support coordinated, whole-person care.
• Participate in team meetings, supervision, training, and ongoing professional development related to care coordination and autism services.
• Effectively manage a mobile caseload, including scheduling, travel, follow-up, and prioritization of member needs.
• Maintain an active community-based practice, with a minimum of 60% of scheduled work time spent in home and community settings conducting assessments, member visits, care coordination activities, and collaboration with providers in alignment with Anthem care coordination standards.

Qualifications & Experience:

·         Bachelor’s degree in social work, psychology, human services, education, nursing, or a related field (or equivalent experience as permitted by payer requirements).

·         Experience working with individuals with autism and/or families of individuals with developmental disabilities.

·         Knowledge of Medicaid, care coordination, or community-based service system.

·         Valid driver’s license, reliable transportation, and ability to travel for home visits.

·         Care coordination or case management experience in a managed care or Medicaid environment

·         Experience providing home-based services preferred.

·         Familiarity with Anthem care coordination models, Medicaid waivers, or managed care organizations preferred.

·         Bilingual or multicultural experience preferred.

Work Environment/Conditions:   Regular travel to family homes and community locations. Work is performed in office, home, and community settings.

Physical Requirement:    Ability to sit, stand, walk and drive for extended periods. Use standard office equipment, communicate effectively, and attend meetings or facilitate training. Occasional lifting.