Location: Vancouver WA
Company Name: Community Health Plan of Washington
Occupational Category: 11-1021.00,General and Operations Managers
Date Posted: 2020-02-09
Valid Through: 2020-03-10
Employment Type: FULL_TIME
Regional Case Manager (Vancouver Office - Not Remote Eligible)
This position works under the general direction of the Manager of Case Management and is responsible for the the plans regional care management coordination programs and processes. The Regional Case Manager will provide case management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness. The Regional Case Manager will also provide case management services for CHPW members with highly complex medical/behavioral and social conditions where advocacy and coordination are required to help the member reach the optimum functional level and autonomy within the constraints of the member's disease conditions.
The Regional Case Manager will represent CHPW during regional meetings regarding care management / care coordination, including presenting / speaking at these meetings. The Regional Case Manager works in the Regional office and coordinates with the CHPW Regional Manager to provide external representation at community and program-based meetings and initiatives.
Essential functions are the basic job duties that an employee must be able to perform, with or without reasonable accommodation.
Coordinate all case management services within assigned areas in order to assure appropriate coordination of services to CHPW members.
Perform the primary functions of assessment, planning, facilitation and advocacy through collaboration with the member and other health care resources involved in the member's care.
Representation of CHPW Care Management Department at regional meetings
Research meeting agenda and planned topics for effective representation.
Effectively prepare and design presentations for regional meetings
Successfully present information on Care Management programs to regional stakeholders, and brings back information to CHPW
Collaborate with HSD / CHPW leadership for presentation preparation
Follow up with appropriate department leadership for any commitments / requests that came from meetings
Work with providers (specialists, CHC, community resources) and vendors to implement programs and monitor health outcomes of case managed members (both complex and non-complex).
Responsible for assessment (HRA) review of members assigned and appropriateness of the level of care and treatment and participate in clinical outcome data collection. Perform other pertinent condition specific assessments as indicated
Develop member interdisciplinary care plans in conjunction with the member's PCP, specialists, and community resources/vendors.
Coordinate with family and caregivers as appropriate.
Coordinate the interdisciplinary/integrated approach to providing continuity of care including, working with the utilization management, TOC teams to assist in transfer coordination, and discharge planning, whenever applicable.
Maintain case management records within the Jiva system.
Exempt 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.
Bachelors degree in a healthcare related field or an equivalent combination of education and highly relevant experience required
Master's Degree preferred/or an equivalent combination of education and highly relevant experience required
License, Certifications, and other Specialized Training
Case Manager Certification desirable
Current, unrestricted license as a LICSW or LMHC, or Registered Nurse with case management experience.
A minimum of one (1) year of case management experience required.
A minimum of two (2) years of experience in use of care management workflow systems;
NCQA standards; and experience meeting with, and presenting to, organizations
Managed care experience preferred (Medicaid / HCA)
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
Knowledge, Skills, and Abilities
Knowledge of regulatory and certification requirements and their impact on the organization such as CMS, HCA, HEDIS, CAHPS, and NCQA.
Strong analytical skills and the ability to interpret, evaluate and formulate action plans based upon data
Experience in care management workflow systems
Effective verbal and written communication skills
Flexibility and willingness to work in a matrix-management environment
Demonstrated organizational, time management, and project management skills
Ability to handle multiple priorities in a fast-paced environment
Ability to multi-task and deal with complex assignments on a frequent basis
Demonstrated proficiency and experience with Microsoft Office products
Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers
Ability to work independently
Ability to present in a group setting
Willingness to be part of a fast moving, and dynamic clinical development team
Collaborate with others in a respectful manner
Perform all functions of the job with accuracy, attention to detail and within established timeframes.
Meet attendance and punctuality standards
Demonstrate professional courtesy to others and ability to maintain confidentiality
Knowledge of and experience with community and other resources
Must be able to work under minimal supervision
? Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.
? Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
? Extended periods of sitting, computer use, talking and possibly standing
? Frequent torso/back static position; occasional stooping, bending and twisting
? Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching
? Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.
Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.
PROTECTED HEALTH INFORMATION (PHI) ACCESS
All information (written, verbal, electronic, etc.) that an employee encounters while working at CHPW is considered confidential. CHPW employees may encounter protected health information in the regular course of their work at and for CHPW. This position may be exposed to and required to deal with highly confidential and sensitive material and must adhere to CHPW policies, guidelines, and all applicable laws and regulations at all times.
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation. This job description is intended to describe the general content and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities or requirements of this position.
Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.nbsp;nbsp;nbsp;nbsp;Regional Case Manager (Vancouver Office - Not Remote Eligible