Community Health Plan of Washington · 4 weeks ago
Case Manager I (MSW/RN) - Medicare/DSNP
United States
Full-time
Remote
Entry, Mid Level
$37.96/hr - $58.84/hr
3+ years expCommunity Health Plan of Washington is committed to a diverse and inclusive workforce. They are seeking a Case Manager I to deliver case management and coordination programs for Medicare and Dual Plan members, focusing on improving quality of life and ensuring cost-effective outcomes through community resources.
Health Care
Responsibilities
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
Works within a multi-functional team to connect 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
Assesses, evaluates, plans, implements, and documents care of members within the organization’s clinical database system, in accordance with organizational policies and procedures
Responsible for the assessment of members, including identifying and coordinating access to the appropriate level of care and treatment. Uses the assessment information to assign the appropriate risk and complexity level, and create and document a care plan in coordination with the member, family and health team input
Initiates a plan of care based on member-specific needs, assessment data and the medical/behavioral plan of care. Goals for members are measurable and developed in conjunction with the patient/family to improve quality of life
Plans care in collaboration with members of the multidisciplinary team, and considers the physical, behavioral, cultural, psychosocial, spiritual, age specific and educational needs of the member in the plan of care
Reviews and revises the plan of care with the interdisciplinary care team to reflect changing member needs based on evaluation of the members’ status, and/or as a result of reassessment
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. Engages community resources where applicable
Conducts interdisciplinary care team meetings with the member/family to assess care plan and recommend adjustments as indicated
Continuously evaluate members’ progress towards goals, identify potential barriers to attaining goals and expected outcomes in collaboration with other health care team members
Documents all case activity using the CHPW care management system and follows documentation standards and protocols
Collaborates with the Transition of Care (TOC) team if a member is hospitalized
Serves as a liaison at various local and statewide meetings and/or workgroups and provides clinical support to providers’ network to enhance integrated care coordination
Assesses barriers to care and assist members and health care team to address concerns
Implements developed workflow activities and activities for designated programs
Conduct member case management in the field at Provider(s) office, member’s home, inpatient medical or psychiatric hospitals, skilled nursing facilities, adult family homes, or in a community setting
Attend member appointments or care conferences in collaboration with the members care team when indicated
This position may requires traveling on behalf of the Company and working in the field. It is essential that a current driver’s license, proof of insurance and an acceptable driving record are maintained
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
Qualification
Required
Possess Current, unrestricted license in the State of Washington as a registered nurse (RN)
Current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC)
Current, unrestricted license in the State of Washington as a Mental Health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT)
Have a minimum of one (1) year case management, home health or discharge planning experience; or a combination of education and experience which provides an equivalent background required
Have a minimum of one (1) year facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse/substance abuse disorder treatment experience, required; or equivalent combination of education and experience and/or working with children and families. Experience with those who have disabilities and knowledge of Child and Families Services
Have a minimum three (3) years of clinical experience in an acute care and/or outpatient setting
Experience and proficiency with Microsoft Office products
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)
Preferred
Have a Bachelor's degree in nursing, or a master's degree in social work and/or related behavior health field
Possess a Case Management Certification
Have Bilingual abilities
Knowledge of, and experience with, community resources
Knowledge of Medicare and Medicaid regulations
Experience in care management workflow systems
Benefits
Medical, Prescription, Dental, and Vision
Telehealth app
Flexible Spending Accounts, Health Savings Accounts
Basic Life AD&D, Short and Long-Term Disability
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) Retirement and generous employer match
Employee Assistance Program and Mental Fitness app
Financial Coaching, Identity Theft Protection
Time off including PTO accrual starting at 17 days per year
40 hours Community Service volunteer time
10 standard holidays, 2 floating holidays
Compassion time off, jury duty
Company
Community Health Plan of Washington
For over 30 years, Community Health Plan of Washington (CHPW) has been providing quality health care to Washington families and supporting your choices for health care.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Leanne Berge
Chief Executive Officer
Stacy Kessel, CPA
Chief Financial Officer
Recent News
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