Care Manager I

 In

Website Administrative

Reference Code: 4511

Position Title: Care Manager I
Location: Cincinnati, OH, 45242
Duration: 3 months with possible extension
Target start date: 12/21/2020  

 

Notes:

  • The candidate must reside in the greater Cincinnati or Dayton area – please include zip code upon submission
  • This position will start remote and remain remote. All case management responsibilities including visits and assessments will occur telephonically.
  • The candidate must have either a LSW or RN licensure. Case management experience and healthcare experience is required as well. Waiver experience is a plus.
  • Day to day duties include tele-visits, assessments, care planning, case note documentation, claims review, service arrangement, and responding to member/provider questions, and 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 Nursing or master’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 drivers license with good driving record and be able to drive locally.

 

 

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