Regional Field Case Manager I - North Sound

Community Health Plan of Washington•Bellingham, WA

53d•Hybrid

About The Position

This position works under the general direction of the Supervisor of Care Management and is responsible for the plan's regional field care management and coordination programs and processes. The Regional Field Case Manager will provide care management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness. The Regional Field Case Manager resides within the assigned region to effectively coordinate care between members, providers and community resources. This role also provides care management services for CHPW members with highly complex medical/behavioral and social conditions where advocacy and coordination are required. This role represents CHPW in the community to provide education on care management programs and provide in-person support for members. The Regional Field Case Manager coordinates with internal and external partners to support members, providers and initiatives in the assigned region.

Requirements

Possess a Bachelor's degree in nursing or a master's degree in social work and/or a related behavior health field (required).
Have a current, unrestricted license in the state of Washington as a registered nurse (RN) (required) OR
Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required) OR
Current, unrestricted license in the State of Washington as a Mental health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required)
Have a minimum of one (1) year case management experience; home health or discharge planning experience; or a combination of education and experience which provides an equivalent background required OR
Have a minimum of one (1) year in an acute care, facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse disorder treatment experience, required; or equivalent combination of education and experience and/or working with children and families.
Have experience with those who have disabilities and knowledge of Child and Families Services.
Have a minimum three (3) years of clinical experience and/or outpatient setting (required).
Have a valid state issued drivers' license.
Complete and successfully pass a criminal background check
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
Vaccination requirement (CHPW offers a process for medical or religious exemptions)

Nice To Haves

Have a case management certification.
Are bilingual.
Have experience in managed care (Medicaid/HCA).
Have previous experience in using Care Management software applications.
Have knowledge of, and experience with, community resources.
Experience in care management workflow systems

Responsibilities

Engages with members, providers and agencies in the assigned region to support field care management services.
Provides face-to-face visits to members where telephonic care management is a barrier, to foster effective participation in the care management program.
Identify and partner with emergency response services or other programs in a community that support members who are high utilizers of medical/behavioral health services. Field case management can include meeting members in acute care, emergency room, adult family home, Inpatient behavioral health facilities, shelters, community health centers, members home or member preferred location.
Assesses, evaluates, plans, implements, and documents the care of members within the organizations' clinical database system in accordance with organizational policies and procedures.
Implements the plan of care through direct member care, coordination, and delegation of the activities of the health care team. Promotes continuity of care by accurately and completely communicating to health care team the status of members for whom care is provided.
Evaluates members' progress towards goals, identify potential barriers, assists members in navigating the healthcare system and expected outcomes in collaboration with member and the interdisciplinary care team.
Works within the multi-interdisciplinary care team that collaborates with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs and ensure access to appropriate services to achieve positive health outcomes.
Advocates on behalf of members and facilitates coordination of resources required to help members reach optimum functional levels and autonomy within the constraints of their disease conditions.
Represents CHPW Care Management Department in the community to provide education on care management programs and collaborate with providers and community partners. Leads regional based projects as assigned
Participates in external care conferences and other d/c planning activities that may be needed to prevent a readmission as needed.
Participates in clinical case review with internal interdisciplinary team at Care Management Rounds.
Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
This position requires traveling on behalf of the Company and working in the field at least 50% of the time. It is essential that a current driver's license, proof of insurance and an acceptable driving record are maintained.