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Case Manager

4 months ago

Evansville, United States Professional Management Enterprises Full time
Job DescriptionJob Description

MUST LIVE IN INDIANA

The Community Well Care Coordinator must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordinator must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordinator will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordinator will provide input, as requested by the State, at State-level meetings.

Primary Responsibilities:

  • Selects, manages, develops, mentors and supports staff in designated department or region
  • Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
  • In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
  • Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
  • Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
  • Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
  • Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
  • Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
  • Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
  • Participates in training and coaching of direct reports as needed
  • Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
  • Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders

Required Qualifications:

  • Resident of Indiana
  • BSN or BSW with equivalent experience
  • Registered Nurse with an unrestricted License in Indiana
  • Experience working within the community health setting in a health care role
  • Experience or knowledge of Indiana Medicaid, Medicare, Long term care
  • Experience coaching or mentoring staff
  • Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment

Preferred Qualifications:

  • 3+ year of case management leadership experience within a healthcare industry
  • Background in managed care
  • Case Management experience
  • Certified Case Manager (CCM)
  • Experience / exposure with members receiving long term social supports
  • Experience in utilization review, concurrent review and/or risk management
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Company DescriptionProfessional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.Company DescriptionProfessional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.