Case Manager

BrightSpring Health Services • Princeton, WV

7d

About The Position

The case manager is responsible for the follow-up with the person receiving ADW services to ensure that services are being provided as described in the Service Plan. Assures financial eligibility remains current, submits the MNER in accordance with policy, and addresses changing needs of the person as reported or determined by monthly contact. The role involves referring and procuring any additional services or resources needed, coordinating with all current service providers to develop and present the six-month and annual Service Plans. The Case Manager provides the service plan to all applicable service providers and copies of necessary documents to the person receiving ADW services. They also annually submit a medical necessity evaluation request and personal care requests as needed, and upload documents into the UMC web portal. Assistance is provided with filling grievances, complaints, and fair hearing requests, making fraud and abuse/neglect referrals, and obtaining legal representation when needed. The role ensures services were provided in accordance with the service plan, evaluates social, environmental, services, risks, and support needs of the individual, and develops an individualized service plan detailing all services. The Case Manager coordinates the delivery of care, eliminates fragmentation of services, and assures appropriate use of resources. They proactively identify problems and coordinate services that provide high-quality care to meet complex needs. Advocacy is provided on behalf of the person to ensure continuity of services, system flexibility, integrated services, proper utilization of facilities and resources, and accessibility. The Case Manager ensures that a person’s wishes and preferences are reflected in the service plan development and that a person’s legal and human rights are protected. Follow-up on all service delivery concerns and document in WV IMS, and complete and submit all required administrative and program reports as requested by either BMS or the OA.

Requirements

• Bachelor’s degree in the Human Service field
• Two years of experience with case management or related discipline
• Licensed in West Virginia as a Social Worker or Counselor
• Ability to operate standard computer and communications equipment
• Working knowledge and use of MS Word, Excel, and other software related to job functions
• Knowledge of agency intake/placement procedures and guidelines, necessary forms and standard intake procedures
• Ability to composing correspondence and basic office etiquette and procedures
• Ability to be flexible and meet deadlines
• Ability to handle multiple tasks in an orderly and timely manner
• Ability to coordinate and maintain client files and agency forms
• Willing to travel as needed

Responsibilities

• Assures financial eligibility remains current
• Submits the MNER in accordance with policy
• Addresses changing needs of the person as reported
• Addresses changing needs determined by monthly contact
• Refers and procures any additional services or resources needed
• Coordinates with all current service providers to develop the six-month Service Plan and the Annual Service Plan (or more often as necessary)
• Be present at the six-month service plan meeting and the annual service plan meeting
• Provides the service plan to all applicable service providers including TMH Transition navigators that are providing services to the person
• Provides copies of all necessary document to the person receiving ADW services
• Annually submits a medical necessity evaluation request to the UMC
• Submits WV personal care request for dual services as needed
• Uploads documents into the UMC web portal
• Assists with filling grievances, complaints, fair hearing request
• Makes fraud and abuse/neglect referrals as needed
• Assists with obtaining legal representation when needed, such as medical power of attorney, health care surrogate, etc.
• Ensures services were provided in accordance with the service plan
• Evaluates social, environmental, services, risks, and support needs of the individual
• Develops and writes an individualized service plan which details all services that are to be provided including both formal and informal services that will assist the person to achieve optimum function
• Coordinates the delivery of care, eliminate fragmentation of services, and assure appropriate use of resources
• Proactively identifies problems and coordinate services that provide appropriate high-quality care to meet the individualized and often complex needs of the person
• Provides advocacy on behalf of the person to ensure continuity of services, system flexibility, integrated services, proper utilization of facilities and resources, and accessibility to services
• Ensures that a person’s wishes are preferences are reflected in development of service plan by working directly with the person and all service providers
• Assures that a person’s legal and human rights are protected
• Follows up on all service deliver concerns and document in WV IMS
• Completes and submits all required administrative and program reports as requested by either BMS or the OA

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level