Health Case Manager #1615 - CHANT - Health & Social Services Division

Hamilton County•Chattanooga, TN

6d•Onsite

About The Position

Under general supervision, the Health Case Manager provides case management and care coordination to children and families at risk who are referred to the Hamilton County Health & Social Services Division’s CHANT program. The role supports families in navigating health care, setting goals, accessing appropriate referrals and community resources, and obtaining specialized medical services. The position also performs case documentation, data entry, billing and administrative support for CHANT, Children & Youth with Special Healthcare Needs (CYSHCN), and Children’s Special Services (CSS) programs. The position works with families, primary care physicians, Managed Care Organizations, insurance providers, vendors, CHANT and CSS personnel, Nurse Specialists, and community resources. Duties include screening and assessment, home visits as needed, family education, referral and authorization follow-up, medical-necessity presentations, and advocacy for services. The role uses REDCap and PTMBIS systems and supports billing, records, vendor coordination, telephone calls, and program administration. All Hamilton County Health & Social Services Division employees must keep contact information current and be accessible for public health emergencies. Staff are required to respond when mobilized, and work hours may be modified to meet community needs. This position is essential/situational during inclement weather and may require reporting to or remaining at work during administrative closings. Work may involve irregular hours for on-call coverage or responses to public health threats, and County positions may require holidays, weekends, shift work, or short-notice extensions. All Hamilton County Government positions are in-person and require regular, punctual attendance.

Requirements

Bachelor’s degree in Human Services, Social Sciences, Business, Communications, or a related field; OR an associate degree in one of these fields and two years of direct work experience in an insurance or managed health care setting working with Centers for Medicare & Medicaid Services and TennCare clients; OR the equivalent of a high school diploma and four years of such direct work experience.
Valid driver’s license.
Knowledge of federal, state, and county laws, rules, regulations, policies, and procedures related to health case management.
Knowledge of MCOs and other insurance providers, including their methods, policies, and procedures.
Knowledge of case management practices and procedures, customer service and public relations practices, specialized health care needs of assigned clients, relevant computer hardware, software and peripherals, and community resources.
Ability to accurately and promptly complete referral forms for MCOs and other insurance providers; enter and retrieve data; and maintain accurate, current files and records.
Ability to work with doctors, clinics, and other health care providers to obtain referrals and services for clients.
Ability to use customer service and public relations techniques when responding to inquiries and complaints, establish effective working relationships, coordinate community resources, and communicate effectively orally and in writing.
Complete the HC Defensive Driving course and/or a department-provided Emergency Vehicle Operations Course (EVOC) before operating a County-owned vehicle.
Remain accessible for public health emergency mobilization and respond when called; work hours may be modified during emergencies.
Report to or remain at work during applicable administrative closings due to the position’s essential/situational designation during inclement weather.
Work may require on-call coverage, response to public health threats or emergencies, and irregular hours.
Work in person with regular and punctual attendance; holidays, weekends, shift work, and short-notice extensions of shift hours may be required.

Responsibilities

Provide care coordination for a caseload of medium- to low-risk families referred to the CHANT program.
Conduct screenings and assessments using the CHANT Screening and Assessment Questionnaire.
Help families navigate care and set goals according to pathways of care.
Identify appropriate referrals and community resources based on child and family needs.
Conduct home visits as needed under program guidelines.
Educate families using key educational messages and assist with targeted community outreach activities.
Document CHANT activities and client contacts in REDCap and PTMBIS.
Work with CHANT staff and Nurse Specialist staff to submit client billing and invoices to the State Department of Health CHANT/CYSHCN program.
Enter data into REDCap, PTMBIS, and Managed Care Organization systems; help CYSHCN clients obtain referrals for specialized medical services; present medical necessity to MCOs; complete forms based on physician orders; and assist clients in advocating for services with primary care physicians.
Seek prior authorizations from MCOs and document all contact with or on behalf of clients in the required systems.
Assist CHANT staff with entering client encounters in REDCap and PTMBIS according to program guidelines.
Mail program welcome packets and CHANT/CYSHCN identification cards to families.
Follow up on weekly AP reports, outstanding referrals, required referrals, orders and authorizations, and CYSHCN appointments by telephone or in coordination with Nurse Specialist or Central Office staff.
Assist CHANT personnel with invoices, filing, monthly food request orders, telephone answering, and other administrative work.
Assist program receptionist/secretary with telephone calls for CYSHCN personnel and maintain current physicians’ contact information for accurate referrals.
Request medical records and medical history diagnosis forms.
Maintain an active list of statewide CHANT/CYSHCN vendors and help contact vendors and mail renewal packets as requested by the Tennessee Department of Health.
Work with CSS staff and the Nurse Specialist to submit client billing to the State Department of Health CSS Program, enter PTMBIS data, support specialized-care referrals and authorizations, present medical necessity to MCOs, complete physician-ordered forms, and assist clients with service advocacy.
Document CSS contacts in CSS records and PTMBIS, and copy referrals for client charts.
Follow up on CSS referrals and assist CSS staff with invoices, filing, telephone calls, and maintenance of physician contact information.
Follow up on newborn screening for genetic and hearing loss and on the School Based Dental referral list.
Perform other related duties as assigned.