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Healthcare Advocate

2 months ago

Hamtramck, Michigan, United States HealthCare Support Full time
About the Role

HealthCare Support is seeking a skilled Care Manager to join our team in a Community Based Care Manager role. As a key member of our care management team, you will be responsible for providing high-quality care coordination services to our members.

Key Responsibilities
  • Member Engagement: Engage with members and their natural support systems through strength-based assessments and a trauma-informed care approach.
  • Care Planning: Develop person-centered individualized care plans in collaboration with the inter-disciplinary care team, based on member's desires, needs, and preferences.
  • Barriers Identification: Identify and manage barriers to achievement of care plan goals.
  • Interventions: Identify and implement effective interventions based on clinical standards and best practices.
  • Member Empowerment: Assist with empowering members to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management.
  • Communication: Facilitate coordination, communication, and collaboration with members, the inter-disciplinary care team, and other stakeholders to achieve goals and maximize positive member outcomes.
  • Education: Educate members and their natural supports about treatment options, community resources, insurance benefits, and other relevant information to ensure timely and informed decisions.
  • Ongoing Assessment: Employ ongoing assessment and documentation to evaluate member's response to and progress on the care plan.
  • Member Satisfaction: Evaluate member satisfaction through open communication and monitoring of concerns or issues.
  • Resource Utilization: Monitor and promote effective utilization of healthcare resources through clinical variance and benefits management.
  • Eligibility Verification: Verify eligibility, previous enrollment history, demographics, and current health status of each member.
  • Psychosocial Assessments: Complete psychosocial and behavioral assessments by gathering information from members, family, providers, and other stakeholders.
  • Care Coordination: Oversee timely psychosocial and behavioral assessments and the care planning and execution of meeting member needs.
  • Provider Education: Participate in meetings with providers to inform them of care management services and benefits available to members.
  • ICDS Model: Assist with ICDS model of care orientation and training of both facility and community providers.
  • Gaps in Care: Identify and address gaps in care and access.
  • Post-Discharge Planning: Collaborate with facility-based case managers and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner.
  • Community Resources: Coordinate with community-based case managers and other service providers to ensure coordination and avoid duplication of services.
  • Care Termination: Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required ongoing care coordination.
  • Clinical Oversight: Provide clinical oversight and direction to unlicensed team members as appropriate.
  • Documentation: Document care coordination activities and member response in a timely manner according to standards of practice and company policies regarding professional documentation.
  • Process Improvement: Continuously assess for areas to improve the process to make the members' experience with our company easier and share with leadership to make it a standard, repeatable process.
  • NCQA Standards: Adhere to NCQA standards (CMSA standards below).
Requirements
  • Clinical Licensure: Current unrestricted clinical license in the state of practice as a Registered Nurse, Social Worker, or Professional Clinical Counselor is required.
  • Case Management Certification: Case Management Certification is highly preferred.
  • Advanced Degree: Advanced degree associated with clinical licensure is preferred.
  • Experience: A minimum of three (3) years of experience in nursing or social work or counseling or healthcare profession (i.e., discharge planning, case management, care coordination, and/or home/community health management experience) is required.
  • Medicaid and Medicare Experience: Three (3) years Medicaid and/or Medicare managed care experience is preferred.
Competencies, Knowledge, and Skills
  • Quality and HEDIS: Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation, and adherence.
  • Microsoft Office: Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel.
  • Communication: Ability to communicate effectively with a diverse group of individuals.
  • Multi-Tasking: Ability to multi-task and work independently within a team environment.
  • Healthcare Laws and Regulations: Knowledge of local, state, and federal healthcare laws and regulations and all company policies regarding case management practices.
  • Code of Ethics: Adhere to a code of ethics that aligns with professional practice.
  • CMSA Standards: Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice.
  • Cultural Sensitivity: Strong understanding and sensitivity of all cultures and demographic diversity.
  • Research Interpretation: Ability to interpret and implement current research findings.
  • Community Resources: Awareness of community and state support resources.
  • Critical Thinking: Critical listening and thinking skills.
  • Decision Making: Decision-making and problem-solving skills.
  • Organizational Skills: Strong organizational and time management skills.