Healthcare - Case Manager II Case Manager II

Job Title: Case Manager III
Location: 100% Remote (Must reside in Kentucky – KY 40059)
Duration: 3 Months (Potential for extension)
Shift: Monday to Friday, 8:30 AM – 5:00 PM EST

Job Description:
Will this role be fully remote? Yes
Are there any specific locations the candidates should be in? No, anywhere within the Commonwealth of KY is acceptable.
What is the expected schedule (include dates/time) 8:30-5:00 EST is the typical schedule. Sometimes members request to be called after 5:00. When that happens the CM can flex their schedule to accommodate (work 9:30-6:00, for example) or ask another team member if they’re able to make an after-5:00 call.

The day to day job duties:
This is a clinical role performing care management responsibilities.
This individual will have responsibility for a caseload of members.
This will mean completing health risk assessments (and other assessments if warranted based on the member’s situation), completing individual care plans, helping members connect with resources, coordinating care with member and providers, etc. All work must be completed timely or we will be out of compliance with Medicare requirements.

Top Skills Required:
Strong clinical skills, strong engagement skills (ability to connect with people), excellent time management, and some proficiency with technology and use of applications.

Required Education/Certification(s):
Must be a fully licensed behavioral health professional in the state of KY (LCSW, LMFT, PsyD, LPCC).

MANAGER WILL CONSIDER A CANDIDATE WHO IS AN RN -
Yes, if they have psych nurse background I would consider them. This role will function as BH CM, so they will take any cases that have primary or more intense BH needs. But regardless of background they will also manage members with chronic physical health conditions as well.

Required Years of Experience: 5 years of clinical experience

Is there potential for this to extend past 3 months or convert to a Client FTE? Yes, if there are positive outcomes evident from the addition of this role, the period may be extended and/or Client could consider converting to FTE.

Summary:
Responsible for health care management and coordination of *** members in order to achieve optimal clinical, financial and quality of life outcomes.
Works with members to create and implement an integrated collaborative plan of care.
Coordinates and monitors Client members progress and services to ensure consistent cost effective care that complies with Client policy and all state and federal regulations and guidelines.

Essential Functions:
Provides case management services to members with chronic or complex conditions including:
Proactively identifies members that may qualify for potential case management services. Conducts assessment of member needs by collecting in-depth information from Clients information system, the member, members family/caregiver, hospital staff, physicians and other providers.
Identifies, assesses and manages members per established criteria.
Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
Performs ongoing monitoring of the plan of care to evaluate effectiveness.
Documents care plan progress in Clients information system.
Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
Measures the effectiveness of interventions to determine case management outcomes. Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Client members.
Conducts face to face or home visits as required.
Maintains department productivity and quality measures.
Manages and completes assigned work plan objectives and projects in a timely manner. Demonstrates dependability and reliability. Maintains effective team member relations. Adheres to all documentation guidelines. Attends regular staff meetings.
Participates in Interdisciplinary Care Team (ICT) meetings.
Assists orientation and mentoring of new team members as appropriate.
Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times.
Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.
Complies with required workplace safety standards. Knowledge/Skills/Abilities: Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously.
Strong analytical skills. Knowledge of applicable state, and federal regulations. Knowledge of ICD-9, CPT coding and HCPC.
SSI, Coordination of benefits, and Third Party Liability programs and integration. Familiarity with NCQA standards, state/federal regulations and measurement techniques. In depth knowledge of CCA and/or other Case Management tools.
Ability to take initiative and see tasks to completion.
Computer skills and experience with Microsoft Office Products. Excellent verbal and written communication skills. Ability to abide by Clients policies. Able to maintain regular attendance based upon agreed schedule. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

Required Education:
Bachelors degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).

Required Experience:
5-7 years of clinical experience with case management experience.