Case Manager - Diabetes Care Program (RN preferred)

CHPW•Seattle, WA

4d•Remote

About The Position

Responsible for the operational delivery of the plan’s case management and coordination programs and processes. Provides case management services for CHPW prediabetic and diabetic members with short term, long term, stable, unstable, and predictable course of illness, and/or highly complex medical/behavioral and social conditions. The Case Manager is responsible for performing telephonic case management for members with acute, chronic, and complex needs. Advocates on behalf of members and facilitates coordination of resources required to help members reach optimum functional levels and autonomy within the constraints of their disease conditions. Works within a multi-functional team to connect with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs and ensure access to appropriate services to achieve positive health outcomes. Assesses, evaluates, plans, implements, and documents care of members within the organization’s clinical database system, in accordance with organizational policies and procedures. Responsible for the assessment of members, including identifying and coordinating access to the appropriate level of care and treatment. Uses the assessment information to assign the appropriate risk and complexity level, and create and document a care plan in coordination with the member, family and health team input. Initiates a plan of care based on member-specific needs, assessment data and the medical/behavioral plan of care. Goals for members are measurable and developed in conjunction with the patient/family to improve quality of life. Plans care in collaboration with members of the multidisciplinary team, and considers the physical, behavioral, cultural, psychosocial, spiritual, age specific and educational needs of the member in the plan of care. Reviews and revises the plan of care with the interdisciplinary care team to reflect changing member needs based on evaluation of the members’ status, and/or as a result of reassessment. Implements the plan of care through direct member care, coordination, and delegation of the activities of the health care team. Promotes continuity of care by accurately and completely communicating to health care team the status of members for whom care is provided. Engages community resources where applicable. Conducts interdisciplinary care team meetings with the member/family to assess care plan and recommend adjustments as indicated. Continuously evaluate members’ progress towards goals, identify potential barriers to attaining goals and expected outcomes in collaboration with other health care team members. Documents all case activity using the CHPW care management system and follows documentation standards and protocols. Collaborates with the Transition of Care (TOC) team if a member is hospitalized. Serves as a liaison at various local and statewide meetings and/or workgroups and provides clinical support to providers’ network to enhance integrated care coordination. Assesses barriers to care and assist members and health care team to address concerns. Implements developed workflow activities and activities for designated programs. Conduct member case management in the field at Provider(s) office, member’s home, inpatient medical or psychiatric hospitals, skilled nursing facilities, adult family homes, or in a community setting. Attend member appointments or care conferences in collaboration with the members care team when indicated. This position may requires traveling on behalf of the Company and working in the field. It is essential that a current driver’s license, proof of insurance and an acceptable driving record are maintained. Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards. Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Requirements

Possess Current, unrestricted license in the State of Washington as a registered nurse (RN) OR Current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC)
Minimum of one (1) year case management, home health or discharge planning experience; or a combination of education and experience which provides an equivalent background
Minimum of one (1) year facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse/substance abuse disorder treatment experience; or equivalent combination of education and experience and/or working with children and families.
Minimum three (3) years of clinical experience in an acute care and/or outpatient setting
Experience and proficiency with Microsoft Office products
Complete and successfully pass a criminal background check
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency

Nice To Haves

Bachelor’s degree in nursing and/or related health field
Case Management Certification
Bilingual abilities
Experience with those who have disabilities and knowledge of Child and Families Services
Knowledge of, and experience with, community resources
Knowledge of Medicare and Medicaid regulations
Knowledge and experience with diabetes care, education, and resources
Experience in care management workflow systems
Effective verbal and written communication skills
Organizational, time management, and project management skills
Ability to work independently
Comfortable presenting in a group setting
Perform all functions of the job with accuracy, attention to detail and within established timeframes.
Meet attendance and punctuality standards

Responsibilities

Perform telephonic case management for members with acute, chronic, and complex needs.
Advocate on behalf of members and facilitate coordination of resources.
Connect with providers, members, caregivers, contracted vendors, community resources, and health plan partners.
Assess member's health status, identify care needs, and ensure access to appropriate services.
Assess, evaluate, plan, implement, and document care of members in the clinical database system.
Assess members, identify and coordinate access to the appropriate level of care and treatment.
Assign appropriate risk and complexity level, and create and document a care plan.
Initiate a plan of care based on member-specific needs, assessment data, and the medical/behavioral plan of care.
Plan care in collaboration with members of the multidisciplinary team.
Review and revise the plan of care with the interdisciplinary care team.
Implement the plan of care through direct member care, coordination, and delegation.
Promote continuity of care by communicating member status to the health care team.
Engage community resources where applicable.
Conduct interdisciplinary care team meetings with the member/family.
Evaluate members’ progress towards goals and identify potential barriers.
Document all case activity using the CHPW care management system.
Collaborate with the Transition of Care (TOC) team if a member is hospitalized.
Serve as a liaison at local and statewide meetings and/or workgroups.
Provide clinical support to providers’ network to enhance integrated care coordination.
Assess barriers to care and assist members and health care team to address concerns.
Implement developed workflow activities and activities for designated programs.
Conduct member case management in the field at Provider(s) office, member’s home, inpatient medical or psychiatric hospitals, skilled nursing facilities, adult family homes, or in a community setting.
Attend member appointments or care conferences when indicated.
Travel on behalf of the Company and work in the field.
Report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.