Government Programs Care Manager III

Health Care Service Corporation•Nashville, TN

1d•Hybrid

About The Position

This position is responsible to provide care coordination to members via telephonic and/or field-based care management to inform and educate them on health care programs to address their personal health needs, engaging the member in discussion of adherence to personal health goals, responding to inquiries from members, and supporting clinical operations with provider and member activities. This position will be required to complete member telephonic and/or field-based health screenings, comprehensive health assessments and care planning duties which may require visits to members’ homes and/or facilities to support complex and specialty populations.

Requirements

Registered Nurse (RN) with 2 years direct clinical care to the consumer in a clinical setting or , unrestricted Licensed Professional Counselor (LPC, TX), or Licensed Master Social Worker (LMSW, TX), Licensed Clinical Professional Counselor (LCPC, IL) or Licensed Clinical Social Worker (LCSW, IL & NM) Licensed Marriage and Family Therapist (LMFT, IL & NM), Licensed Professional Clinical Counselor (LPCC, NM), Licensed Independent Social Worker (LISW, NM), or Licensed Mental Health Counselor LMHC, NM) with 2 years of clinical practice experience.
Current, valid, unrestricted license in the state of operations (or reciprocity).
For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
Plus 3 years’ wellness or managed care experience presenting clinical issues with members/physicians.
Knowledge of the health and wellness marketplace and employer trends.
Verbal and written communication skills including discussing medical needs with members and interfacing with internal staff/management and external vendors and community resources.
Analytical experience including medical data analysis.
PC proficiency to include Word, Excel, and PowerPoint, database experience and Web based applications.
Current unrestricted driver’s license, transportation and applicable insurance.
Ability and willingness to travel within assigned territory.
Illinois Only: High-needs children: Bachelor’s degree in nursing, social sciences, social work, or related field (1) year of supervised clinical experience in a human-services field.
Illinois Only: Elderly Waiver Care Coordinators must meet one (1) of the four (4) following requirements: Registered Nurse (RN) licensed in Illinois, Bachelor’s degree in nursing, social sciences, social work, or related field, Licensed Practical Nurse (LPN) with one (1) year experience in conducting comprehensive assessments and provision of formal service for the elderly and/or authorizing service provisions, One (1) year of satisfactory program experience, which is defined as assessment, provision, and/or authorization of formal services for the elderly, may replace one year of college education, at least four (4) years of experience replacing baccalaureate degree.
Illinois Only: Persons with Disabilities Waiver Care Coordinators must meet one (1) of the nine (9) following requirements: Registered Nurse (RN) Licensed Clinical Social Worker (LCSW) Licensed Marriage and Family Therapist (LMFT) Licensed Clinical Professional Counselor (LCPC) Licensed Professional Counselor (LPC) Doctor of Philosophy (PhD) Doctorate in Psychology (PsyD) Bachelor’s or master’s Degree prepared in human services related field Licensed Practical Nurse (LPN).
Illinois Only: Persons with Brain Injury Waiver Care Coordinators must meet one (1) of the seven (7) following requirements: Registered Nurse (RN) licensed in Illinois, Certified or Licensed social worker, Unlicensed social worker: minimum of bachelor’s degree in social work, social sciences, or counseling, Vocational specialist: certified Rehabilitation counselor or at least three (3) years’ experience working with people with disabilities, Licensed Clinical Professional Counselor (LCPC), Licensed Professional Counselor (LPC), Certified Case Manager (CCM).
Illinois Only: Persons with HIV/AIDS Waiver Care Coordinators must meet one (1) of the three (3) following requirements: A Registered Nurse (RN) licensed in Illinois and a bachelor’s degree in nursing, social work, social sciences, or counseling or one (1) years of case management experience. A Social worker with a bachelor’s degree in either social work, social sciences, or counseling (A Bachelor of Social Work or a Master of Social Work from a school accredited by any organization nationally recognized for the accreditation of schools of social work is preferred). Individual with a bachelor’s degree in a human services field (including, but not limited to sociology, special education, rehabilitation counseling) with a minimum of one (1) years of case management experience.
Illinois Only: In addition, it is mandatory that the Care Coordinator for Enrollees within the Persons with HIV/AIDS Waiver have experience in working with racial and ethnic minorities, as well as one or more of the following: Domestic Abuse, The lesbian, gay, bisexual, transgender, queer (LBGTQ+) community, Persons living with HIV/AIDS, and Persons with substance use disorders.
Texas Only: Level 3 children with behavioral health issues-experience in working with children and young adjusts with similar conditions or behaviors in three of the last 5 years.

Nice To Haves

3 years direct clinical experience.
Patient education experience.
Condition Management experience.
Bilingual in English and Spanish.
Experience in managing complex or catastrophic cases.
Certification in Case Management, Training, Project Management or nationally recognized health care certification.
Government Programs experience.
Population Management.

Responsibilities

Provide care coordination to members via telephonic and/or field-based care management.
Inform and educate members on health care programs to address their personal health needs.
Engage members in discussion of adherence to personal health goals.
Respond to inquiries from members.
Support clinical operations with provider and member activities.
Complete member telephonic and/or field-based health screenings.
Conduct comprehensive health assessments and care planning duties.
Conduct visits to members’ homes and/or facilities to support complex and specialty populations.