Healthcare Professional
4 weeks ago
We are seeking a motivated and experienced Case Manager, RN to join our team in Delaware. As a key member of our healthcare team, you will provide community-based care coordination/management for our clients' members in the state.
This is a full-time position that requires flexibility to work in a hybrid setting. You must reside in and be legally authorized to work in the U.S. to be eligible for this role.
About the Role:As a Case Manager, RN, you will travel to members' homes, nursing facilities, and other community-based settings to complete face-to-face needs assessments. You will then follow up with telephonic contact to ensure that the member's needs are being met.
Your primary responsibility will be to assess, plan, coordinate, implement, and evaluate care for eligible members with chronic and complex healthcare, social service, and custodial needs. You will work closely with the client's healthcare and service delivery team to coordinate care across the continuum of services.
You will facilitate authorization, coordination, continuity, and appropriateness of care and services in community or HCBS settings. Additionally, you will facilitate transitions to alternate care settings such as hospital to home, nursing facility to community setting, using an integrated care team to address the member's specific needs.
You will educate members or caregivers regarding healthcare needs, available benefits, resources, and services, including options for long-term care community or facility-based service delivery. You will also provide education, resources, and assistance to help members achieve their goals as outlined in their plan of care.
In conjunction with members or caregivers, you will develop a plan of care to identify services to meet the member's specific needs and goals. You will also identify resources needed for a fully integrated care coordination approach, including facilitating referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
You will collaborate with the member's healthcare and service delivery team, including the DSHP Plus LTSS Member Advocate, ICT, and discharge planners, to coordinate the care needs and community resources for the member. Your goal will be to maintain the member in the least restrictive safe environment possible.
You will assist members in developing, implementing, and amending a back-up plan for gaps in provider coverage. You will ensure that approved support services are being provided as outlined in the plan of care, and evaluate the effectiveness of the service plan making appropriate revisions as needed.
You will document all case management services and interventions in the electronic health record, adhering to all company, state, and federal requirements related to privacy practices, HIPAA, and quality performance standards.
You will perform other duties as assigned/requested.
Requirements:To be considered for this position, you must have:
- A current Registered Nurse (RN) license in the state of Delaware.
- At least 2 years of experience in Case Management and Discharge Planning, including experience discharging members from a facility setting.
- Experience completing assessments, developing service plans, and care plans.
- Experience collaborating with Primary Care Physicians (PCPs), Occupational Therapists, Behavioral Health providers, and other healthcare professionals.
- Experience ordering Durable Medical Equipment (DME).
- Experience educating and providing resources for members' Social Determinants.
- Ability to work flexible hours to meet members' needs.
- Proficiency in PC-based word processing and database documentation software (Word, Excel, Internet, Outlook).
- Reliable transportation daily to travel within assigned territory.
- Ability to meet regulatory deadlines.
- Dedicated workspace used only for business purposes, and ability to comply with all telecommuter policies.
- Experience in geriatric special needs, behavioral health, and home health.
- Understanding of the importance of cultural competency in addressing targeted populations.
- Experience with electronic documentation systems.
- Experience with cost neutrality and budgeting.
- Ability to communicate clearly to members, who may be contacted over the phone.
PREFERRED QUALIFICATIONS:
- Certified Case Manager (CCM)
- Licensed Bachelor's Social Worker (LBSW)
- Licensed Master's Social Worker (LMSW)
- Licensed Clinical Social Worker (LCSW)
- Experience working with HIV/AIDS populations.
- Experience working with behavioral health populations.
- Experience working with developmental disabilities populations.
- Medicare and Medicaid experience.
CAI is an equal opportunity employer committed to diversity and inclusion. We do not discriminate against any employee or applicant due to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or being a protected veteran.
Estimated Salary:$65,000 - $85,000 per year, depending on experience.
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