Case Management Lead

1 month ago

Roseville, United States Gainwell Technologies LLC Full time
Summary

As a Case Management representative at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable.

Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

Gainwell empowers you to help clients deliver better health and human services outcomes using innovative technology and solutions, enabling you to design your career for growth, new possibilities, and refinement of your valuable skills. Here are the details on this position.

Your role in our mission

•    Intake and evaluation of members for case management

•    Collaborate with multi-disciplinary team to perform risk assessment, implement and monitor plan of care

•    Schedule and coordinate complex treatment plans involving dental and medical providers. Make referrals to appropriate clinical specialists 

•    Obtain authorizations and approvals for medically necessary dental care. Assist with obtaining supporting ancillary services

•    Monitor members adherence to treatment, appointments, and receipt of care. Update and adjust plan of care as needed. Record case information, accurately complete all necessary forms and produce

statistical reports/information as needed
 

What we're looking for

•    Proven work experience in Case Management with a preferred minimum of three (3) to five (5) years of experience in a relevant Case Management position in the healthcare or insurance industry with

Medicaid and/or Medicare knowledge and experience strongly desired

•    Previous lead or management experience in monitoring performance standards of a team and supporting client escalations

•    Clinical and/or Dental health experience is preferred. Strong knowledge of dental treatment authorization request processes, procedures, and documentation is preferred

•    Professional or personal experience supporting individuals with disabilities, chronic illnesses, or experiencing homelessness preferred Highly organized with a strong ability to manage different priorities 

•    Ability to work with others and use resources to problem solve 

•    Apply good judgment to fast-changing situations 

•    Effective verbal and written communication skills, exceptional interpersonal, customer service, negotiation, and problem-solving skills.

•    Ability to build relationships with different types of people, including clients, caregivers, family members, community-based organizations, and members of the health care 

•    Collaboration across teams 

•    Strong understanding of cultural and linguistic competency 

•    Education and experience:  LMSW/LCSW/LMHC or RN/LPN degree

•    Must be a resident of California

•    Ability to work in a hybrid environment 2 -3 days/week, located in Roseville, CA.

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