Case Manager

4 weeks ago

Denver, United States Rocky Mountain Human Services Full time

We value an equitable and inclusive workplace and seek candidates with diverse backgrounds and abilities

Why work at Rocky Mountain Human Services?
You will have the opportunity to contribute to an organization that is dedicated to embracing the power of community to support individuals and families in creating their future.

RMHS provides great benefits such as:

  • Employer paid medical options, dental, and vision benefits
  • Generous paid time off such as vacation, sick, personal, and holidays
  • Life and disability insurance
  • Tuition reimbursement (full-time employees only)
  • Mileage reimbursement
  • 403(B) with company match
  • Employee assistance program

Case managers serve as the main contact for members receiving Long Term Services and Supports through Medicaid or State Funded programs. The case manager provides specialized, ongoing case management by monitoring services, having communication with members and providers, and coordinating resources and requests as needed. Case managers serve as the experts in eligibility assessments, service plans, and prior authorization requests (PARs). 

Essential Duties

  • Responds to correspondence from the member, family or provider within two business days. This can include questions, requests, concerns, status updates, etc.
  • Completes in-person eligibility and monitoring visits with the member at their residence.
  • Completes quarterly monitoring visits with the member and/or designated team member as assigned. This may be an in person or virtual visit depending on the client’s preference.
  • Schedules assigned assessments and service plans with the member and, if appropriate, care team in the timeframe required.
  • Completes all assigned and required assessments and service plans with the member and, if appropriate, care team in the member’s residence.
  • Ensures the PAR is completed prior to services being implemented and matches the assessment and service plan.
  • Completes all CDASS and IHSS required paperwork as part of the annual service plan process.
  • Submits utilization reviews to the utilization management vendor and responds to all follow up requests in a timely manner.
  • Coordinates with members and providers to ensure PARs and plans are accurate. Responds to requests for follow up within two business days.
  • Ensures certifications are submitted to the county to prevent eligibility breaks.
  • Responds to the complex needs of members and represents RMHS in team meetings to determine services and supports needed to meet the member’s needs.
  • Assists members and their care teams to find appropriate service providers and/or necessary resources.
  • Initiates revisions to the service plan by collecting information and understanding the needs of the member and care team.
  • Completes all necessary paperwork according to rules and regulations to properly implement a rights modification for the member to be safe and healthy.
  • Monitors and responds to incident reports and critical incident reports.
  • Responsible for the management of an assigned caseload.
  • Completes closures or terminations, as needed, ensures members understand the complaint and appeal process.
  • Maintains professional and ethical behaviors in all interactions with members, care teams, and RMHS internal staff while meeting expectations and quality standards set by RMHS.
  • Participates in training and staff development activities as assigned, including team meetings.
  • Facilitates team meetings with care teams (primarily for IDD waivers and programs)
  • Completes Mill Levy requests for members and/or their care team (primarily for IDD waivers and programs)
  • Completes FSSP and State SLS plans (children’s and state team/CM only)
  • Performs other duties as assigned.

Knowledge, Skills, and Abilities                                                                                                              

  • Communicates professionally and empathetically both verbally and in writing.
  • Knowledge, understanding and competency about members who have disabilities and members who are elderly.
  • Maintains confidentiality per HIPAA guidelines.
  • Ability to manage your own schedule and work hours to effectively complete tasks assigned.
  • Ability to manage multiple priorities and work in a fast-paced environment.
  • Ability to speak calmly and help de-escalate members who may be upset by showing care and compassion.
  • Ability to solve problems and concerns as they arise.
  • Ability to attend in-person meetings with members at their residence.
  • Knowledge of basic computer skills and ability to navigate client management systems.
  • Ability to represent RMHS’s mission, vision, and values.

Minimum Qualifications

  • A bachelor’s degree; or
  • Five (5) years of relevant experience in the field of LTSS, which includes Developmental Disabilities; or
  • Some combination of education and relevant experience appropriate to the requirements of the position.

Preferred Qualifications

  • Previous case management experience
  • Degree in social work, psychology, sociology or other human services
  • Spanish Speaking

Driving Category - Requirements

Driving Category B:

Employees who may drive RMHS or personal vehicles for business purposes. Category B employees may transport other employees but will not transport RMHS clients.

  • Valid driver’s license
  • Proof of motor vehicle insurance
  • Personal vehicle in good operating condition for use during work, including transporting individuals
  • No major violations in the past three years.
  • No more than two moving violations in the past three years
  • Ability to meet and maintain agency driving requirements and operate agency vehicles
  • Drivers must upload proof of ongoing auto insurance every 6 months into Paycom/Relias.

Employment Type: Full Time
Salary: $22 - $25 Hourly
Bonus/Commission: No

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