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Integrated Care Case Manager

2 months ago

Brownsville, Texas, United States DirectEmployers Full time

JOB DESCRIPTION

Position Overview


DirectEmployers is seeking a dedicated Case Manager to join our Healthcare Services team. This role involves collaborating with members, healthcare providers, and multidisciplinary teams to assess, facilitate, and coordinate a comprehensive delivery of care across various settings, including behavioral health and long-term services for individuals with significant needs.

The Case Manager will play a crucial role in ensuring that patients achieve their health goals through quality care that is both medically appropriate and cost-effective, tailored to the severity of their conditions and the service environment.


KEY RESPONSIBILITIES
1. Conduct face-to-face comprehensive assessments of members within regulated timelines.

2. Facilitate the enrollment and disenrollment processes for comprehensive waivers.

3. Develop and implement a personalized case management plan, including waiver service plans, in partnership with the member, their caregivers, physicians, and other relevant healthcare professionals to meet the member's needs and objectives.

4. Monitor the effectiveness of care plans, documenting interventions and achievements, and recommending adjustments as necessary.

5. Promote the integration of services for members, including behavioral health and long-term services, to enhance continuity of care.

6. Assess medical necessity and authorize appropriate waiver services.

7. Evaluate covered benefits and provide guidance on funding sources.

8. Conduct home visits or face-to-face meetings as required.

9. Organize interdisciplinary care team meetings to discuss service approvals or denials and facilitate informal collaboration.

10. Utilize motivational interviewing techniques and clinical guidelines to educate and support members during interactions.

11. Identify barriers to care and provide coordination and assistance to members addressing psychosocial, financial, and medical challenges.

12. Recognize critical incidents and develop prevention strategies to ensure the health and safety of members.

13. Offer consultation and recommendations to non-RN case managers as needed.

14. Manage cases involving members with complex medical conditions and medication regimens.

15. Perform medication reconciliation when necessary.

Travel Requirement: 50-75% travel may be necessary.

QUALIFICATIONS

Education
Must be a graduate from an accredited nursing program.

Experience
Minimum of 1 year of experience working with individuals with disabilities or chronic conditions and long-term services and supports.

1-3 years of experience in case management, disease management, managed care, or medical/behavioral health environments.

Licensure/Certification
Must hold an active, unrestricted State Registered Nursing license (RN) in good standing.

If fieldwork is required, a valid driver's license with a good driving record is necessary, along with reliable transportation.


State-Specific Requirements

Virginia:
At least one year of experience working directly with individuals with Substance Use Disorders is required.

Preferred Qualifications
Bachelor's Degree in Nursing is preferred.

3-5 years of experience in case management, disease management, managed care, or medical/behavioral health settings is preferred.

1 year of experience working with populations receiving waiver services is preferred.

Preferred Licensure/Certification
Active and unrestricted Certified Case Manager (CCM) certification is preferred.

Compensation Information:

Competitive salary and benefits package offered. Actual compensation may vary based on geographic location, work experience, education, and skill level.