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ECHO Program Case Management Specialist

2 months ago

Atlanta, Georgia, United States Pacer Staffing Full time

Shift - Standard | Mon to Fri

Location – Remote

(Case Manager – focusing on complex conditions in children, including Down syndrome and other significant disabilities.)

Position 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) with severe intellectual or physical disabilities. This initiative offers additional financial support beyond the standard TRICARE plan, ensuring a comprehensive array of services aimed at mitigating the impacts of qualifying conditions.

Primary Duties:

  • Deliver case management services to TRICARE beneficiaries qualifying for the ECHO, ensuring they have access to necessary equipment and services as clinically appropriate, adhering to TRICARE guidelines.
  • Conduct clinical evaluations for requested ECHO services in accordance with established policies, collaborating with Medical Directors as required.
  • Serve as a subject matter expert on the ECHO benefit while possessing a thorough understanding of the TRICARE basic benefit framework.
  • Apply knowledge of HIPAA privacy regulations and URAC accreditation standards to maintain compliance in daily operations.
  • Perform comprehensive case management assessments and formulate individualized care plans to assist beneficiaries in accessing quality care efficiently.
  • Collaborate with Primary Care Managers (PCMs) or specialty health providers to gather insights for the individualized care plan, ensuring it is accessible to all relevant parties.
  • Regularly reassess and update care plans at least monthly to address emerging needs, treatment services, and funding options.
  • Document activities and implement necessary changes in the medical management system.
  • Evaluate case management outcomes, focusing on beneficiary satisfaction and adherence to the care plan.
  • Prepare and present complex cases to the Medical Director for review, particularly those involving sensitive issues.
  • Advocate for beneficiaries by ensuring they receive necessary care, maintaining safety, and identifying specialized services outside the network.
  • Provide TRICARE and community resource information, along with internal care referrals, to meet care plan objectives.
  • Screen for high-risk factors that may indicate the need for complex case management services from non-ECHO case managers.
  • Maintain knowledge of and adhere to URAC Foundational Standards and departmental norms.
  • Oversee and guide non-clinical staff as needed.
  • Regular and reliable attendance is essential.
  • Additional responsibilities as assigned.

Qualifications:

Required:

  • Current unrestricted licensure as a Licensed Clinical Social Worker or Registered Nurse in an appropriate U.S. state or territory.
  • U.S. Citizenship is mandatory.
  • Ability to pass a favorable 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 severe intellectual or physical disabilities.
  • Two years of case management experience.
  • URAC-recognized case manager certification.

Competencies:

  • Communication Skills: Ability to effectively influence and engage individuals in diverse situations, adapt communication styles, actively listen, and foster collaboration.
  • Technical Proficiency: Skilled in utilizing various Microsoft applications and departmental software within a multi-system environment.
  • Adaptability: Capable of navigating diverse situations while maintaining a sense of purpose and employing mature critical thinking skills.
  • Customer Service Orientation: A customer-centric approach that emphasizes patience, respect, and attentive listening.
  • Initiative: Resourceful critical thinker with the ability to prioritize tasks and secure necessary resources.
  • 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: Proficient in systematic analysis and sound judgment.
  • Team Collaboration: Able to positively influence group dynamics and engagement.
  • Technical Knowledge: Thorough understanding of Case Management, TRICARE policies, HIPAA regulations, and medical coding principles.

Work Environment:

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