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High Intensity Case Manager

Location : Remote
Job Type : Temp/Contract
Reference Code : Remote
Job Industry : Healthcare - Health Services

Job Description :
Overview: 

The scope of the High-Risk Case Manager is to effectively manage members on an outpatient basis to ensure the appropriate level-of-care is provided for complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admissions and ensure that the members’ medical, environmental and psychosocial needs are optimize over the continuum of care.

 

Responsibilities: 



  • Identifies appropriate members for case management and conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.

  • Develop Individual Care Plan (ICP) by conditions identified in health plan HRA, patient assessment, medical records authorizations/referrals, primary care physician, member, and Interdisciplinary Care Team (ICT). Setting members prioritized and self-management goals.

  • Case Manager’s ability to effectively manage a panel/caseload of high-risk members in collaboration with Nurse Practitioner, Pharmacist, PCP, SPC, health plans and other ICT members.

  • Create cases in Essette for each case managed member with appropriate documentation including but not limited to; cognitive, functional, ADL, environmental factors, psychosocial, medical and benefits etc.

  • Provides appropriate documentation including but not limited to; cognitive, functional, ADL, environmental factors, psychosocial, medical and benefits etc.

  • Collaborate with member’s family and physicians for seamless coordination of care and services

  • Collaborate and coordinate care with Health plans, Community Based Programs (CBAS), Managed Long Term Supportive Services (MLTSS) and Behavioral Health Providers

  • Monitors and evaluate effectiveness of the care management plan and modify as necessary based on members’ progress, changes in condition and to minimize unnecessary utilizations, admissions, and readmissions.

  • Interfaces with Medical Director and attends IDT as required.

  • Conducts outbound calls to assigned high risk case managed members. Occasional, in person visit may be needed to better facilitate members’ care.

  • Collaborate with member, member’s family, and physicians for seamless coordination of care and services.

  • Collaborate and coordinate care with health plans, Community Based Programs (CBAS), Multiple Long Term Support Services (MLTSS) and Behavioral Health providers.

  • Meet health plans and NCQA requirements in turn-around-time for assessments, care plans and IDTs.



 

 
Required Qualifications :
Qualifications: 


 


Minimum Experience: 



  •  At least two (2) years’ experience in the medical field required.  

  • One (1) year experience in a case management role required. 

  • At least two (2) years’ experience in ambulatory case management, preferably in a managed care organization, medical group, or health plan setting required. Knowledgeable in NCQA requirements preferred.


 


Req. Certification/Licensure: 



  • RN/LVN unrestricted active license required. CCM Certification preferred.


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