Case Manager

Position Purpose:

Responsible for health care management and coordination of healthcare 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 member’s progress and services to ensure consistent cost effective care that complies with policy and all state and federal regulations and guidelines.

• Proactively identifies members that may qualify for potential case management services.
• Conducts assessment of member needs by collecting in-depth information from the information system, the member, member’s 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 the 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 members.
• Maintains department productivity and quality measures.
• Manages and completes assigned work plan objectives and projects in a timely manner.
• Attends regular staff meetings.
• Participates in Interdisciplinary Care Team (ICT) meetings.
• Assists orientation and mentoring of new team members as appropriate.

Required Skills & Education:

• Bachelor’s degree in a health or human services field required
• Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW
• 1 year of experience working directly with individuals who meet the Cardinal Care Priority Population (Medicaid) criteria.

#INDAS

Job Type: Full-time

Pay: $46.34 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Medicaid: 1 year (Required)
• Case management: 2 years (Required)

License/Certification:

• RN, LCSW or APSW (Required)

Location:

• Virginia (Required)

Work Location: Remote

Salary : $46