Healthcare - Care Manager III
: Job Details :

Job Title: Care Manager IIILocation: RemoteDuration: 6 Months Job Description: Will the position be 100% remote? There are some circumstances that CM need to visit mbr at home or in facilityBut the chance is extremely low. Are there any specific location requirements? No- They can sit anywhere in US as long as they are licensed in NY State but they will not be able to convert to perm if they are not in tri state area. What are the must have requirements? Knowledge of MLTC and NY Medicaid policyActually creating the care plans for adult/ geriatric patientsNot just working with MLTC dept coordinatorAlso NOT in just a hospital or nursing home or facility. What specific experience do they need to have/know? MLTC experience, Acknowledge of UAS Assessment. What are the day to day responsibilities? Outreach calls and Person-Centered Care Plan reviewsCoordinate care, manager caseload, create Patient Centered Service Plans. Is there specific licensure is required in order to qualify for the role? RN/LMSW/LCSW- Licensed in the State of NY What languages are required? Spanish What sort of case load will this person manage? 2-3 PCSP review per day, or 225-230 caseloadFor context the NY Health plan added 940 new members last month.Must have previous experience working remoteSelf-motivated, tech savvy and able to work indecently to complete a min of 7 successful calls a day,At the end of the month the CM must have 125 contacts with members.Will require- laptop, keyboard, mouse, headset, dual monitors and a docking station.Summary: Responsible for health care management and coordination of *** members in order to achieve optimal clinical, financial and quality of life outcomesWorks with members to create and implement an integrated collaborative plan of careCoordinates 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: o Proactively identifies members that may qualify for potential case management serviceso Conducts assessment of member needs by collecting in-depth information from Clients information system, the member, members family/caregiver, hospital staff, physicians and other providerso Identifies, assesses and manages members per established criteriao Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needso Performs ongoing monitoring of the plan of care to evaluate effectivenesso Documents care plan progress in Clients information systemo Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomeso Measures the effectiveness of interventions to determine case management outcomesPromotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Client membersConducts face to face or home visits as requiredMaintains department productivity and quality measuresManages and completes assigned work plan objectives and projects in a timely mannerDemonstrates dependability and reliabilityMaintains effective team member relationsAdheres to all documentation guidelines activitiesAttends regular staff meetingsParticipates in Interdisciplinary Care Team (ICT) meetingsAssists orientation and mentoring of new team members as appropriateMaintains professional relationships with provider community and internal and external customersConducts self in a professional manner at all timesMaintains cooperative and effective workplace relationships and adheres to company Code of ConductParticipates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growthComplies with required workplace safety standards Knowledge/Skills/Abilities:Demonstrated ability to communicate, problem solve, and work effectively with peopleExcellent organizational skill with the ability to manage multiple prioritiesWork independently and handle multiple projects simultaneouslyStrong analytical skillsKnowledge of applicable state, and federal regulationsKnowledge of ICD-9, CPT coding and HCPCKnowledge of SSI, Coordination of benefits, and Third Party Liability programs and integrationFamiliarity with NCQA standards, state/federal regulations and measurement techniquesIn depth knowledge of CCA and/or other Case Management toolsAbility to take initiative and see tasks to completionComputer skills and experience with Microsoft Office ProductsExcellent verbal and written communication skillsAbility to abide by Clients policiesAble to maintain regular attendance based upon agreed scheduleMaintain 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 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 Required Licensure/Certification:Must have valid drivers license with good driving record and be able to drive locally.