Regional Case Manager I

This is a remote from home position, however it will also require travel within Pierce County.

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to apply an equity lens to all our work.
• Reduce health disparities.
• Become an anti-racist organization
• Create an equitable work environment.

About the Role

This position works under the general direction of the Manager of Case Management and is responsible for the the plan’s regional care management coordination programs and processes. The Regional Case Manager will provide case management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness. This role also provides case management services for CHPW members with highly complex medical/behavioral and social conditions where advocacy and coordination are required. This role represents CHPW during regional meetings regarding care management / care coordination, including presenting / speaking at these meetings. The Regional Case Manager coordinates with the CHPW Regional Manager to provide external representation at community and program-based meetings and initiatives.

To be successful in this role, you:

• Possess a Bachelor’s degree in nursing or a master’s degree in social work and/or a related behavior health field (required)
• Have a current, unrestricted license in the state of Washington as a registered nurse (RN) (required) OR
• Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required) OR
• Current, unrestricted license in the State of Washington as a Mental health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required)
• Have a minimum of one (1) year of case management experience (required)
• Have a minimum of two (2) years of experience in use of care management workflow systems; NCQA standards; and experience meeting with, and presenting to, organizations (required)

Preferred

• Have a case management certification
• Are bilingual
• Have experience in managed care (Medicaid/HCA)
• Have previous experience in using Care Management software applications
• Have knowledge of, and experience with, community resources

Essential functions and Roles and Responsibilities:

• Coordinate all case management services within assigned areas in order to assure appropriate coordination of services to CHPW members.
• Perform the primary functions of assessment, planning, facilitation and advocacy through collaboration with the member and other health care resources involved in the member's care.
• Representation of CHPW Care Management Department at regional meetings
• Research meeting agenda and planned topics for effective representation.
• Effectively prepare and design presentations for regional meetings
• Present information on Care Management programs to regional stakeholders, and brings back information to CHPW
• Collaborate with HSD / CHPW leadership for presentation preparation
• Follow up with appropriate department leadership for any commitments / requests that came from meetings
• Work with providers (specialists, CHC, community resources) and vendors to implement programs and monitor health outcomes of case managed members (both complex and non-complex).
• Responsible for assessment (HRA) review of members assigned and appropriateness of the level of care and treatment and participate in clinical outcome data collection. Perform other pertinent condition specific assessments as indicated
• Develop member interdisciplinary care plans in conjunction with the member's PCP, specialists, and community resources/vendors..
• Coordinate with family and caregivers as appropriate.
• Coordinate the interdisciplinary/integrated approach to providing continuity of care including, working with the utilization management, TOC teams to assist in transfer coordination, and discharge planning, whenever applicable.
• Maintain case management records within the Jiva system.
• Exempt – Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

• Knowledge of regulatory and certification requirements and their impact on the organization such as CMS, HCA, HEDIS, CAHPS, and NCQA.
• Strong analytical skills and the ability to interpret, evaluate and formulate action plans based upon data
• Experience in care management workflow systems
• Strong organizational, time management, and project management skills
• Ability to handle multiple priorities
• Ability to multi-task and deal with complex assignments on a frequent basis
• Proficiency and experience with Microsoft Office products
• Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers
• Ability to work independently
• Comfortable presenting in a group setting
• Perform all functions of the job with accuracy, attention to detail and within established timeframes.
• Meet attendance and punctuality standards
• Demonstrate professional courtesy to others and ability to maintain confidentiality
• Knowledge of and experience with community and other resources

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn’t perfectly check every box in the job description, we encourage you to apply anyway.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check
  • Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.
• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking, and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion

Mental:

• Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.

*Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

*The above is intended to describe the general content of and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities, or requirements of this position. Job descriptions may be updated or changed to reflect business needs.