Description:
Will this role be fully remote?: Yes, this position is fully remote
Is there potential for this to extend past 6 months and/or convert to an FTE?:
This is also a possibility no immediate plans.
Summary:
- Responsible for health care management and coordination of *** members in order to achieve optimal clinical, financial and quality of life outcomes.
- Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors
- Client members progress and services to ensure consistent cost effective care that complies with Client policy and all state and federal regulations and guidelines.
Essential Functions:
- Provides case management services to members with chronic or complex conditions including:
- Proactively identifies members that may qualify for potential case management services.
- Conducts assessment of member needs by collecting in-depth information from Clients information system, the member, members family/caregiver, hospital staff, physicians and other providers.
- Identifies, assesses and manages members per established criteria.
- Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
- Performs ongoing monitoring of the plan of care to evaluate effectiveness.
- Documents care plan progress in Clients information system.
- Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes
- Measures the effectiveness of interventions to determine case management outcomes.
- Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Client members.
- Conducts face to face or home visits as required.
- Maintains department productivity and quality measures.
- Manages and completes assigned work plan objectives and projects in a timely manner. Demonstrates dependability and reliability.
- Maintains effective team member relations.
- Adheres to all documentation guidelines. Attends regular staff meetings.
- Participates in Interdisciplinary Care Team (ICT) meetings.
- Assists orientation and mentoring of new team members as appropriate. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times.
- Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.
- Complies with required workplace safety standards.
Knowledge/Skills/Abilities:
- Demonstrated ability to communicate, problem solve, and work effectively with people.
- Excellent organizational skill with the ability to manage multiple priorities.
- Work independently and handle multiple projects simultaneously.
- Strong analytical skills. Knowledge of applicable state, and federal regulations.
- Knowledge of ICD-9, CPT coding and HCPC. SSI, Coordination of benefits, and Third Party Liability programs and integration.
- Familiarity with NCQA standards, state/federal regulations and measurement techniques.
- In depth knowledge of CCA and/or other Case Management tools.
- Ability to take initiative and see tasks to completion.
- Computer skills and experience with Microsoft Office Products.
- Excellent verbal and written communication skills.
- Ability to abide by Clients policies.
- Able to maintain regular attendance based upon agreed schedule. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
- Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
Required Education:
Bachelors degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).
Required Experience:
0-2 years of clinical experience with case management experience.
Required Licensure/Certification:
Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing.