Care Manager I

 In

Website Administrative

Reference Code: 4298

Position Title: Care Manager 

Duration: 3 months contract with possible extension

Desired Start Date: 10/21/2020

Location:Columbus, OH, 43235

Candidate Submission Limit Per Supplier: 2

Notes:

  • The Physical Work Location is currently set as “Remote”. The position will start Remote, and then transition to the Columbus, Ohio
  • The resource will conduct 100% telephonic assessments until field work is permitted. The locations for the work are in the Columbus and Dayton areas.
  • Must have requirements for this position: An unrestricted active State Registered Nursing (RN) license in good standing, or an unrestricted active Licensed Social Worker (LSW or LISW) in good standing. Columbus and Dayton areas.

 

Day-to-day responsibilities:

  • Case managing a patient caseload of nursing facility Members for the MMP Duals MyCare Ohio program. Which includes the ability to complete comprehensive assessments of members per regulated timelines and determine who may qualify for case management based on clinical judgement.
  • The ability to develop and implement a case management plan of care and collaborate with member, caregiver, physician or other appropriate healthcare professionals, and members support network. The ability to conduct face to face or home visits as required. The ability to perform ongoing monitoring of the members care through quarterly reviews, annual assessments, and post discharge assessments as needed.
  • The ability to maintain ongoing member caseloads for regular outreach and management.
  • The ability to promote integration of services for members including behavioral health care, long term services and supports, and home and community to enhance the continuity of care for Members. The ability to assess for barriers to care and provides care coordination and assistance to member to address concerns.

 

Summary:

  • Responsible for health care management and coordination of Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes.
  • Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors member’s progress and services to ensure consistent cost-effective care that complies with policy and all state and federal regulations and guidelines.
  • Provides case management services to members with chronic or complex conditions including:
  • Proactively identifies members that may qualify for potential case management services.  Conducts assessment of member needs by collecting in-depth information from information system, the member, member’s family/caregiver, hospital staff, physicians and other providers.
  • Identifies, assesses and manages members per established criteria.  
  • Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
  • Performs ongoing monitoring of the plan of care to evaluate effectiveness.
  • Documents care plan progress in information system.
  • Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
  • Measures the effectiveness of interventions to determine case management outcomes.
  • Promotes integration of services for members including behavioral health and long-term care to enhance the continuity of care for members.
  • Conducts face to face or home visits as required.
  • Maintains department productivity and quality measures.
  • Manages and completes assigned work plan objectives and projects in a timely manner.
  • Demonstrates dependability and reliability.
  • Maintains effective team member relations.
  • Adheres to all documentation guidelines.
  • Attends regular staff meetings.
  • Participates in Interdisciplinary Care Team (ICT) meetings.
  • Assists orientation and mentoring of new team members as appropriate.
  • Maintains professional relationships with provider community and internal and external customers.
  • Conducts self in a professional manner at all times.
  • Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
  • Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.
  • Complies with required workplace safety standards. 

Knowledge/Skills/Abilities:

  • Demonstrated ability to communicate, problem solve, and work effectively with people.
  • Excellent organizational skill with the ability to manage multiple priorities.
  • Work independently and handle multiple projects simultaneously.
  • Strong analytical skills.
  • Knowledge of applicable state, and federal regulations.
  • Knowledge of ICD-9, CPT coding and HCPC. Knowledge of SSI, Coordination of benefits, and Third-Party Liability programs and integration.
  • Familiarity with NCQA standards, state/federal regulations, and measurement techniques.
  • In depth knowledge of CCA and/or other Case Management tools.
  • Ability to take initiative and see tasks to completion.
  • Computer skills and experience with Microsoft Office Products.
  • Excellent verbal and written communication skills.
  • Ability to abide by  policies.
  • Able to maintain regular attendance based upon agreed schedule.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers, and customers.

Requirements

  • Required Education: Bachelor’s Degree in Social Work or Health Education (a combination of experience and education will be considered in lieu of degree).
  • Required Experience: 0-2 years of clinical experience with Case Management experience.
  • Required Licensure/Certification: Must have valid driver’s license with good driving record and be able to drive locally.

 

 

 

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