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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 professional to join our team as a Case Manager specializing in Long-Term Services and Supports (LTSS). In this role, you will collaborate with members, healthcare providers, and a multidisciplinary team to assess, facilitate, and coordinate comprehensive care tailored to individuals with significant needs.

Your primary focus will be to ensure that our members receive high-quality, medically appropriate, and cost-effective care throughout their healthcare journey.


KEY RESPONSIBILITIES
1. Conduct thorough face-to-face assessments of members in accordance with established timelines.

2. Manage the enrollment and disenrollment processes for comprehensive waiver services.

3. Develop and execute a personalized case management plan, including waiver service plans, in partnership with members, caregivers, and healthcare professionals to meet individual needs and objectives.

4. Continuously monitor and evaluate the effectiveness of care plans, documenting interventions and progress towards goals, and making necessary adjustments.

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

6. Assess medical necessity and authorize appropriate waiver services.

7. Provide guidance on covered benefits and funding sources as needed.

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

9. Facilitate interdisciplinary team meetings to discuss service approvals or denials and promote collaboration.

10. Utilize motivational interviewing techniques to educate and empower members during interactions.

11. Identify barriers to care and provide coordination and support to address psychosocial, financial, and medical challenges.

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

13. Offer consultation and support to non-RN case managers as necessary.

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

15. Perform medication reconciliation when required.

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

QUALIFICATIONS

Education
Must be a graduate from an accredited nursing program.

Experience
Minimum of 1 year working with individuals with disabilities or chronic conditions, particularly in Long-Term Services & Supports.

1-3 years of experience in case management, disease management, managed care, or healthcare settings.

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:
Minimum of one year of experience working directly with individuals with Substance Use Disorders.

Preferred Qualifications
Bachelor's Degree in Nursing is preferred.

3-5 years of experience in case management, disease management, managed care, or healthcare 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:

$23.76 / Hourly - $51.49 / Hourly

*Compensation may vary based on geographic location, work experience, education, and skill level.

DirectEmployers is an Equal Opportunity Employer (EOE) M/F/D/V.