Case Manager

Independent Health

5d•$36 - $38

About The Position

FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration. Overview The Case Manager (CM) will be responsible for helping members achieve a level of well-being, to avoid preventative hospital admissions or readmissions through the administration of quality improvement functions. The CM will perform telephonic outreach to members, physicians, or other care givers to develop a plan of care for the member who needs CM services. The CM will perform case management functions using a member-centric, collaborative process to optimize the wellness and functional capability of members, using available resources to promote quality cost-effective outcomes. The Case Manager will apply the guiding principles for case management practice to include assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet a member’s comprehensive health needs. The CM will adhere to regulatory and compliance requirements, adhere to department productivity and quality metrics, and provide exceptional customer service to all internal and external customers.

Requirements

Registered Nurse (RN) with active, current, unrestricted NYS license, licensed master social worker (LMSW), master’s in social work (MSW), or licensed dietician with case management experience required.
Case Management Certification (CCM) required. Candidates without CCM certification are required to obtain it within two (2) years of commencing employment.
Two (2) years of case management or clinical experience in acute medical/surgical/critical care or ambulatory setting required.
Proficient computer and Windows skills required, including MS Office.
Clinical knowledge of the health and social needs of the population served.
Ability to identify barriers to a successful case management path.
Excellent critical thinking and time management skills.
Excellent written, verbal, and interpersonal communication skills with ability to provide exceptional customer service to external and internal customers to include telephonic interviewing of members; motivational interviewing skills a plus.
Transferable knowledge, skill, and ability to complete job duties independently and proficiently.
Flexibility in work schedules and assignments required.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Nice To Haves

Previous clinical experience in a managed care setting as a case/care manager preferred.

Responsibilities

Assess the patient’s broad spectrum of immediate and long-term needs through evaluation of the patient’s social and medical history.
Develop a plan of care based upon providers of care clinical assessments and patients, to identified population along the continuum of care staying within the scope of case management practice.
Provide ongoing assessment and documentation to monitor member’s response to the plan of care; revises as needed based on changes in the member’s condition, lack of response to the care plan, preference changes, transitions across settings, and barriers to care and services.
Measure and report outcomes that demonstrate the efficacy, quality, and cost-effectiveness of case management interventions to achieve goals.
Conduct comprehensive assessments of the member’s health and psychosocial needs to include health literacy, cultural, clinical and laboratory data, claims history, contract and benefit language, related state and federal regulations, established clinical guidelines, and recent literature or research as appropriate to ensure valid case management decisions.
If selected by the Plan and approved by the NYSDOH, effectively serve as the Plan Foster Care Liaison who shall be responsible for clinical management and care coordination with OCFS, LDSS, and the VFCAs for all shared Medicaid children in foster care.
Facilitate communication and coordination between members of the healthcare team; facilitate safe transition of care along the healthcare continuum.
Identify cases that would benefit from alternative care through assessment and evaluation of the patient’s needs, as well as available resources.
Apply appropriate medical policies to evaluate the medical necessity, appropriateness and efficient use of healthcare services, procedures, and facilities across the continuum of care.
Identify and review high-risk cases to ensure members are transitioned to the appropriate care.
Document the patient’s plan of care in a timely manner.
Employ evidence-based guidelines and other self-management resources to maximize the member’s health, wellness, safety, adaptation, and self-care.
Understand case management concepts such as roles, philosophies, principles, liability, and confidentiality issues. Apply these concepts in developing appropriate plan of care and goals based on the needs of the patient.
Improve outcomes by utilizing adherence guidelines, standardized tools, and proven processes to measure a member’s understanding and acceptance of the care plan, willingness to change, and their support to maintain health behavior change.
Ensure compliance with regulatory standards as indicated; adhere to applicable local, state, and federal laws, as well as employer policies, governing all aspects of case management practice, including member privacy and confidentiality rights.
Actively participates in project teams and medical management initiatives as needed.
Assist in the orientation of associates as needed.