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

Hamilton County • Chattanooga, TN

8d • Hybrid

About The Position

Under general supervision, provides case management services to children and families at risk in the Health & Social Services Division. Assists referring clients to their primary care physicians or other identified professionals. Assists clients in navigating the system to receive specialized care. Provides record and data keeping and works with community resources. Hamilton County Health & Social Services Division employees are responsible for ensuring their contact information is current and they are accessible should a public health emergency arise. During a public health emergency, all staff are required to respond should a call to mobilize be made, and work hours are subject to modification to meet the needs of the community.

Requirements

• A Bachelor’s degree in Human Services, Social Sciences, Business, Communications or a related field.
• OR An Associate’s degree in Human Services, Social Sciences, Business, Communications or a related field and two (2) years of direct work experience in an insurance or managed health care setting working with Centers for Medicare & Medicaid Services and TennCare clients.
• A valid driver’s license is required.
• OR The equivalent of a high school diploma and four (4) years of direct work experience in an insurance or managed health care setting working with Centers for Medicare & Medicaid Services and TennCare clients.
• A valid driver’s license is required.
• Knowledge of federal, state, and county laws, rules, regulations, policies and procedures related to health case management.
• Knowledge of MCO, and other insurance providers, methods, policies and procedures.
• Knowledge of case management practices and procedures.
• Knowledge of customer service/public relations methods and practices.
• Knowledge of specialized health care needs of assigned clients.
• Knowledge of computer hardware, software and peripherals pertinent to assignment.
• Knowledge of community resources related to area of assignment.
• Skill accurately and timely completing referral forms for MCO and other insurance providers.
• Skill accurately and timely entering and retrieving data from computerized systems.
• Skill maintaining accurate updated files and records.
• Skill working with doctors, clinics, and other health care providers in seeking referrals and services for clients.
• Skill utilizing customer service/public relations techniques when responding to inquiries and complaints.
• Skill establishing and maintaining effective working relationships.
• Skill coordinating community resources based on client needs.
• Skill effectively communicating in both oral and written form.
• Prior to operating a County-owned vehicle, all employees are required to complete the HC Defensive Driving course and/or an Emergency Vehicle Operations Course (EVOC) provided at the department level.

Nice To Haves

• Work involves extensive use of computer keyboarding and telephoning while convincing PCP and MCO providers to refer and see clients.
• Work requires working with high risk, confrontational, mentally and physically ill, and economically disadvantaged populations with exposure to infectious diseases.
• Some positions require outreach and home visitation.
• Work may involve working after regular business hours in high crime areas, or making home visits.

Responsibilities

• Provides Care Coordination for a caseload for medium to low risk families that have been referred to the CHANT program.
• Conducts a screening and assessment with individual/families utilizing the CHANT screening and Assessment Questionnaire.
• Assists the family in navigation of care and goal setting per pathways of care.
• Identifies appropriate referrals/resources based on the child/family needs.
• Conducts home visits as needed according to the program guidelines.
• Educates families using key educational messages.
• Assists in planning and participating in targeted community-based outreach activities.
• Documents CHANT efforts completely using the Research Electronic Data Capture (REDCap) data capturing system.
• Works as a team with CHANT staff.
• Assists as a CHANT Health Case Manager working with the Nurse Specialist staff to submit client billing/invoices to the State Department of Health CHANT/Children & Youth with Special Healthcare Needs (CYSHCN) program.
• Enters data into REDCap / Patient Tracking & Bill Management Information System (PTMBIS) Managed Care Organization (MCO) system.
• Assists CYSHCN clients to obtain referrals for specialized medical services.
• Presents the medical necessity of each case to MCO.
• Completes all forms based on doctor's orders and assists clients with advocating for services with primary care physician (PCP).
• Seeks prior authorizations from MCO.
• Documents all contact with or on behalf of clients/patients on CHANT/CYSHCN in REDCap system and into the PTBMIS (computerized state network) system.
• Assists CHANT staff with entering client encounters in the REDCap system and PTBMIS system on a regular basis per program guidelines.
• Mails welcome packet to families on the program including the CHANT/CYSHCN identification card.
• Follows up on weekly AP report received from Central off CHANT/CYSHCN staff.
• Follows up on referrals that have been requested but not received.
• Contacts PCPs to remind of referrals, orders and authorizations necessary for services.
• Tracks and follows up on CYSHCN appointments via telephone or by following up with Nurse Specialist or Central office.
• Assists CHANT personnel in processing invoices, filing, monthly food request orders, and answering the telephone.
• Assists program receptionist/secretary in making telephone calls for CYSHCN personnel.
• Updates and maintains current doctors’ addresses and telephone information for accurate referrals.
• Performs other related duties as assigned.
• Requests medical records and medical history diagnosis form to be completed.
• Keeps an ongoing active list of current CHANT/CYSHCN statewide vendors and assists with contacting vendors and mailing renewal packets per the TN Dept. of Health’s request.
• Works with Children’s Special Services (CSS) Staff and the Nurse Specialist to submit client billing to the State Department of Health CSS Program.
• Enters data into PTMBIS system.
• Assists CSS clients to obtain referrals for specialized medical services.
• Presents medical necessity of each case to Managed Care Organization (MCO).
• Completes all forms based on doctor’s orders.
• Assists clients with advocating for services with primary care physician (PCP).
• Seeks prior approval from MCO.
• Documents all contact with or on behalf of clients/patients in CSS records and into the PTBMIS (computerized state network) system and coping referral for client’s charts.
• Follows up on referrals that have been requested but not received.
• Contacts PCPs to remind of referrals necessary for services.
• Assists CSS personnel in processing invoices, filing and answering telephone.
• Assists receptionist in making telephone calls for CSS personnel.
• Updates and maintains current doctor’s addresses and telephone information for accurate referrals.
• Follows up with the Newborn Screening for Genetic and Hearing loss to follow up and the School Based Dental referral list.

Benefits

• All positions within Hamilton County Government may require work on Holidays or weekends.
• Additionally, irregular hours and shift work may be required, including possible extension of shift hours, at times with short notice.

What This Job Offers

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