ECHO Program Case Manager

2 weeks ago

Atlanta, Georgia, United States Pacer Staffing Full time

Shift - Standard | Mon to Fri

Location – Remote

(Case Manager – serious diagnoses. Children/Pediatric with down syndrome, serious disabilities, physical disabilities.)

Job Overview:

  • This role involves delivering case management services to TRICARE beneficiaries enrolled in the Extended Care Health Option (ECHO). The ECHO program supplements the TRICARE Basic Program, providing essential services and supplies to eligible Active-Duty Family Members (ADFMs) facing significant intellectual or physical disabilities. This program offers an additional financial resource designed to mitigate the disabling effects of qualifying conditions.

Primary Responsibilities:

  • Deliver case management services to TRICARE beneficiaries qualifying for the ECHO, ensuring access to necessary equipment and services in accordance with TRICARE policies.
  • Conduct clinical evaluations for requested ECHO services, collaborating with Medical Directors as required.
  • Serve as a subject matter expert on the ECHO benefit while maintaining comprehensive knowledge of the TRICARE basic benefit structure.
  • Ensure compliance with HIPAA privacy and security regulations and URAC accreditation standards in daily operations.
  • Perform thorough case management assessments and create personalized care plans to facilitate access to quality care efficiently.
  • Collaborate with Primary Care Managers (PCM) or specialty health providers to gather insights for individualized care plans, sharing these plans with all relevant parties.
  • Regularly reassess and adjust care plans to address emerging needs, services, and funding options.
  • Maintain detailed documentation of activities and implement necessary changes in the medical management system.
  • Evaluate case management outcomes, focusing on beneficiary satisfaction and adherence to care plans.
  • Present complex cases involving sensitive issues to the Medical Director for review.
  • Advocate for beneficiaries by ensuring they receive necessary care and maintaining their safety, including locating specialized services outside the network.
  • Provide TRICARE and community resource information, along with internal care referrals to meet care plan objectives.
  • Identify high-risk factors that may necessitate complex case management services from non-ECHO case managers.
  • Stay informed about and comply with URAC Foundational Standards and departmental norms.
  • Supervise and guide non-clinical staff as needed.
  • Consistent and reliable attendance is essential.
  • Perform other related duties as assigned.

Qualifications:

Required:

  • Current unrestricted licensure as a Licensed Clinical Social Worker or Registered Nurse in a U.S. state or territory.
  • U.S. Citizenship.
  • Ability to pass a favorable Interim and final Department of Defense (DoD) background investigation.
  • Minimum of three years of full-time equivalent direct clinical care experience.
  • Capability to obtain a URAC-recognized certification in case management within four years of employment.

Preferred:

  • Two years of experience working with individuals with serious intellectual or physical disabilities.
  • Two years of experience in case management.
  • URAC-recognized case manager certification.

Skills and Competencies:

  • Communication Skills: Ability to effectively influence and engage individuals in diverse situations, adapt communication styles, actively listen, and foster collaboration.
  • Technical Proficiency: Competence in using various Microsoft applications and departmental-specific software within a multi-system environment.
  • Adaptability: Ability to navigate diverse situations while maintaining focus and employing critical thinking skills.
  • Customer Service Orientation: A customer-centric approach characterized by patience, respect, and attentive listening.
  • Initiative: Resourceful critical thinker capable of prioritizing tasks and demonstrating commitment to achieving desired outcomes.
  • Time Management: Proficient in managing tasks to meet evolving deadlines in a high-volume environment.
  • Organizational Skills: Skilled in coordinating tasks and adapting to changing priorities efficiently.
  • Problem-Solving: Competent in systematic analysis and sound judgment regarding pertinent issues.
  • Team Collaboration: Ability to positively influence group dynamics and foster engagement.
  • Technical Knowledge: Comprehensive understanding of Case Management, Utilization Management, TRICARE policies, HIPAA regulations, and medical coding principles.

Work Environment:

  • Flexibility to cover various work shifts.
  • Availability for overtime as needed.
  • Remote work requires a private, secure workspace with high-speed internet.
  • Extensive computer work necessitating prolonged sitting, headset use, typing, and phone communication.

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