Healthcare - Case Manager II

4 weeks ago

Virginia, United States APN Consulting, Inc Full time
Job Title: Healthcare - Case Manager II
Location: Remote (Must be local to VA)
Duration: 6 Months

Job Description:
Work Location (i.e., onsite or remote based): Remote (but must reside in the state of VA and will be looking for coverage potentially across the state) Please review VA region map attached in job description.
Reason for Job Request: Seeing significant staffing fluctuations as a result of market uncertainty during RFP

Must Have Skills:
Must have a valid driver's license and reliable vehicle for field visits
Excellent communication skills, with an ability to communicate effectively with members with chronic conditions, developmental disabilities, etc.
Strong technical skills (utilizing multiple programs at the same time) along with competency in Microsoft applications (Outlook, Teams, Excel, etc.)
Strong organizational and interpersonal skills

Day to Day Responsibilities: Will be responsible for performing case management activities according to the contractual requirements and in alignment with NCQA requirements
This will include potential home visits to complete assessments as well as completion of telephonic assessments, completion of integrated care plans, and conducting interdisciplinary care team meetings
In addition, conducting needed telephonic follow-up, education, and care coordination for assigned members.

Required Years of Experience: One year of experience working directly with individuals who meet the Cardinal Care Priority Population (Medicaid) criteria.

Required Licensure / Education: Must have Bachelor's degree in a health or human services field, LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW

Must work 8-5 pm EST
Candidates will need laptop, keyboard, mouse, headset and 1 additional monitor.

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: o Proactively identifies members that may qualify for potential case management services
o 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
o Identifies, assesses and manages members per established criteria
o 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
o Performs ongoing monitoring of the plan of care to evaluate effectiveness
o Documents care plan progress in Clients information system
o Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes
o 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:
2-4 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
A combination of experience and education will be considered in lieu of LCSW or APSW
Must have valid drivers license with good driving record and be able to drive locally.

Comments for Suppliers: Candidates MUST meet education requirements.

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