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Healthcare - Case Manager II Case Manager II
4 months ago
Duration: 3 months
REMOTE
Job Description:
Is this position remote? Yes, the position is remote.
o Are there any location requirements? Living in CA is preferred, or able to work Pacific Time Zone business hours.
Weekly schedule/hours: 8:30 am - 5: 00 pm Pacific Time Zone
Client would be interested in a case manager who has worked with children, and they don't have to be an RN or LVN, exactly.
They could have a Bachelor's or Master's Degree (preferably in a social science, psychology, public health or social work or related field).
Spanish Speaking would be preferred, but not mandatory.
Of course, it would also be great if they have worked previously with the same client and are familiar with our systems.
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 members progress and services to ensure consistent cost effective care that complies with 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 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 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 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 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.
