Medical Case Manager

Care Resource Community Health Centers, Inc.•Miami, FL

7h•Onsite

About The Position

The Medical Case Manager provides medical caseload management for eligible health center patients and service-area residents. The role helps clients enroll in affordable health insurance coverage through the Health Insurance Marketplaces, Medicaid, or the Children’s Health Insurance Program; assesses individual needs and eligibility for medical and social services; and connects clients with available community programs. The case manager builds rapport, supports clients’ progress in medical treatment, coordinates medical care, and works with physicians, colleagues, and external providers to reduce barriers to treatment. The position includes home, hospital, and community visits; hospital discharge planning; coordination of post-hospital care; tracking of medications, labs, diagnostic tests, and appointments; and counseling to support treatment adherence. The case manager develops and monitors individualized service plans, documents services and progress in client records and electronic systems, prepares reports, and coordinates with a supervisor when challenges arise. The role also requires knowledge of community and public programs, management of client budgets stipulated by the State of Florida, support for billing and reconciliation across data systems, and participation in required training and agency activities. Safety duties include following hand-washing guidance, accurately documenting medications, ensuring clients understand their medicines, screening new clients for suicide risk, and following assigned emergency and continuity-of-operations procedures. Work is primarily performed in an office, with some work in clients’ homes, community agency settings, and hospitals. Own transportation is required. The role requires a bachelor’s degree in a behavioral science field, two years of related experience, and one year of HIV/AIDS experience. Required certifications and trainings include an annually renewed Affordable Care Act Certified Application Counselor Certificate, Case Management Medicaid Provider Certification, and specified HIV/AIDS and case management trainings within 90 days of hire.

Requirements

Bachelor’s degree in a behavioral science field such as Social Work, Nursing, or Psychology.
Two years of related experience.
One year of HIV/AIDS experience.
HIV/AIDS 104, 500, and 501 training and State- or County-provided Case Management training within 90 days of hire.
Affordable Care Act Certified Application Counselor Certificate, required annually.
Case Management Medicaid Provider Certification.
Submit a completed application and fingerprinting to the supervisor within 30 days of hire.
Own transportation required.
Ability to perform frequent internal and external contacts and provide courteous, attentive, protocol-compliant customer service.

Responsibilities

Provide outreach and enrollment assistance to help eligible patients and service-area residents enroll in affordable coverage through the Health Insurance Marketplaces, Medicaid, or CHIP.
Interview prospective clients to determine needs and eligibility for medical or social services and enroll them in available community programs.
Build rapport with clients and support their progress in medical treatment.
Coordinate, support, and follow up on medical treatments, including coordinating with physicians and mobilizing appropriate services.
Maintain the average annual active caseload assigned by the supervisor.
Serve as a liaison, coordinator, and advocate among coworkers, medical departments, community providers, and agencies to remove barriers to care.
Conduct home and hospital visits and visits with the State of Florida’s contracted disease management firm as needed to determine acuity and level of care.
Plan hospital discharges and coordinate post-hospital care based on client needs.
Track client labs, medications, diagnostic tests, medical and therapy appointments, and hospital visits to support adherence to treatment and service plans.
Provide ongoing medication and treatment counseling using treatment-adherence assessment tools.
Ensure documentation is timely, accurate, legible, and clear.
Develop individualized service plans or plans of care; monitor their effectiveness and reassess or adjust them as needed.
Empower clients to participate in treatment planning and maintain treatment plans, progress notes, and reviews in client records according to applicable policies and standards.
Enter client information electronically according to agency and departmental guidelines.
Maintain accurate time sheets reflecting time spent in each program and prepare requested program reports and records.
Coordinate with the supervisor to address unusual challenges.
Maintain knowledge of community services and programs and explain medical, insurance, and other state and federal program options, coverage, services, and procedures to clients.
Bill at least six hours in an eight-hour workday.
Manage and balance monthly and annual client budgets stipulated by the State of Florida, as applicable.
Support billing through concurrent documentation of services and budget activities, including reconciling information across PCIS, web-based systems, CASEWATCH, and client records.
Participate in required staff training and agency or health center developmental activities.
Follow CDC hand-washing guidance and accurately document patients’ medications; ensure patients know which medicines to take at home and encourage them to bring an updated medication list to appointments.
Ensure each new client receives suicide-risk screening and understand and follow assigned roles in the Emergency Code System and Agency Continuity of Operations Plan.
Perform other duties as assigned.