Medical Case Manager

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

22h•Hybrid

About The Position

The Medical Case Manager plays a crucial role in assisting eligible health center patients and residents in accessing affordable health insurance through Marketplaces, Medicaid, or the Children’s Health Insurance Program. This position focuses on improving client health by building rapport, facilitating progress in medical treatment, and coordinating care. The role involves interviewing clients to assess needs and eligibility for various services, coordinating and supporting medical treatments, and maintaining an active caseload. The Medical Case Manager acts as a liaison between departments and community providers to remove barriers to care, conducts home and hospital visits, and coordinates with physicians for service mobilization and discharge planning. Maintaining organized systems for tracking client progress, including labs, medications, and appointments, is essential for ensuring treatment compliance and client improvement. The role also includes providing ongoing medication and treatment counseling and ensuring all documentation is timely, accurate, legible, and clear. Developing individualized service plans, monitoring treatment efficacy, and empowering clients in their treatment planning are key responsibilities. The position requires inputting client information electronically, maintaining accurate time records, and preparing program reports. Additionally, the Medical Case Manager must maintain comprehensive knowledge of community services, assist clients in understanding available programs, and manage program budgets. Billing support through concurrent documentation and participation in staff training are also required. The role involves participating in agency developmental activities and other assigned duties, ensuring proper safety protocols are followed, including handwashing, correct medication documentation, suicide risk screening, and understanding emergency codes and continuity of operations plans.

Requirements

Bachelor’s Degree in a behavioral science field like Social Work, Nursing or Psychology is required.
Two (2) years of related experience are required.
One year of HIV/AIDS experience is required.
HIV/AIDS 104, 500 & 501 and Case Management training provided by the State or County are required within 90 days of hire date.
Affordable Care Act Certified Application Counselor Certificate required annually.
Case Management Medicaid Provider Certification is required.
Completed application and fingerprinting submitted to supervisor within 30 days of hire.
Own transportation required.

Responsibilities

Provides outreach and enrollment assistance activities and facilitates enrollment of eligible health center patients and service area residents into affordable health insurance coverage through the Health Insurance Marketplaces, Medicaid, or the Children’s Health Insurance Program.
Creates rapport within client interaction to help each progress in their medical treatment.
Interviews prospective clients to determine individual needs and eligibility for various medical and social services, enrolling them into available community programs.
Coordinates, support and follows up on medical treatments.
Maintains an average annual active caseload as assigned by the supervisor.
Serves as a liaison, coordinator and/or advocate between various co-workers within the Case Management, Medical Care departments or other community medical or agency service provider to remove barriers to treatment/care for clients.
Uses knowledge of individual programs to conduct home visits, hospital visits and one visit with the State of Florida’s contracted disease management firm to develop acuity level of care as needed.
Coordinates with physicians for appropriate service mobilization.
Discharge planning from hospitalizations that coordinates post hospital care based upon client needs.
Maintain organized systems of tracking client labs, medication, diagnostic testing, medical, therapy and hospital visits to help clients remain compliant with treatment and service plans; all with the goal of seeing clients progress toward improvements in their lives.
Provides ongoing medication and treatment counseling through use of treatment adherence assessment tools.
Ensures all documentation is Timely, Accurate, Legible and Clear.
Develops comprehensive, individualized service plans or plans of care.
Monitors clients to assess efficacy of treatment plans and re-assesses and adjusts as necessary.
Empowers clients to participate in their treatment planning.
Maintains treatment plans, progress notes and progress reviews in client records as specified in agency policy, program guidelines and performance standards.
Input client information using electronic data entry according to agency and departmental guidelines.
Maintains an accurate record on time sheet reflecting time spent in each program worked (e.g. Ryan White 75 hrs, Medicaid Waiver 5 hrs, ACA 10 hrs).
Prepares necessary program reports and records as requested by the supervisor and/or manager.
Coordinates with supervisor when necessary to meet unusual challenges.
Maintains comprehensive knowledge of community services to apply knowledge of services to individual client needs.
Utilizes knowledge of community programs to help clients understand the different types of medical, insurance and other programs offered under State and Federal Programs as required.
Bills a minimum of six hours in an 8-hour day.
Uses program knowledge to provide clients with information about bill-coverage, services and procedures as required.
Controls, manages, and balances, monthly, the annual budget stipulated by the State of Florida for each appropriate client.
Supports billing through concurrent documentation of service provided and budget activities as required (i.e. reconciling billing across data systems including: PCIS, Web-based systems, CASEWATCH and client records).
Participates in staff training sessions within the timeframes specified and as required by the agency and the funding source.
Participates in agency developmental activities as requested.
Other duties as assigned.
Ensure proper hand washing according to Centers for Disease Control and Prevention guidelines.
Documents patient’s medications correctly, makes sure each patient knows which medicines to take when they are at home and encourages each patient to bring their up-to-date list of medicines every time they visit the doctor.
Ensure each new client receives screening for their risk of suicide.
Understands and appropriately acts upon assigned role in Emergency Code System.
Understands and performs assigned role in Agency Continuity of Operations Plan (COOP).
Greets internal or external customers (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language.
Listens to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring and understanding of the request and providing appropriate options or resolutions.
Provides services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered.
Takes initiative and anticipates internal or external customer needs by engaging them in the process and following up as needed.
Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure the prompt and effective response is provided.
Ensures proper handwashing according to the Centers for Disease Control and Prevention guidelines.
Understands and appropriately acts upon the assigned role in Emergency Code System.
Understands and performs assigned roles in the organization’s Continuity of Operations Plan (COOP).
Participates in health center developmental activities as requested.
Other duties as assigned.