Case Manager Long-term Care - (RN) New Castle County, Delaware Highmark Inc.
Job Summary This job serves as the single point of contact for members to coordinate all of the members care needs across the various service delivery systems and community supports. This is a full-time community-based position requiring frequent travel within the assigned territory in DE. A significant portion of this role involves working directly with members in their homes and also requires providing case management services within nursing facility settings. The incumbent will travel to members homes, nursing facilities, and other community-based settings for individuals enrolled in DSHP Plus LTSS and DSNP.
Essential Responsibilities
Conduct regular in-home and nursing facility visits to complete face-to-face needs assessments and subsequent telephonic contact in accordance with state and national guidelines, policies, procedures, and protocols. Includes participating in nursing facility care plan conferences to ensure member needs are met.
Assess, plan, coordinate, implement, and evaluate care for eligible members with chronic and complex health care, social service, and custodial needs in nursing facility or home and community-based care settings.
Coordinate care across the continuum of services and assist members physical, behavioral, long-term services and supports (LTSS), social, and psychosocial needs in the safest, least restrictive way possible while considering cost-effectiveness. Includes ensuring appropriate care transitions between home, community, and other settings.
Authorize LTSS services based on completion of a comprehensive needs assessment; coordinate HCBS services, Medicaid and DSNP benefits and assess appropriateness of community care.
Facilitate transitions to alternate care settings such as hospital to home or nursing facility to community using an integrated care team.
Educate members or caregivers regarding health care needs, available benefits, resources, and services including options for long-term care community or facility-based delivery.
Provide education, resources, and assistance to help members achieve plan of care goals and overcome obstacles to optimal care in the least restrictive environment.
Develop individualized care plans with members or caregivers to identify services that meet specific needs and goals.
Identify resources needed for a fully integrated care coordination approach, including referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
Collaborate with the members health care and service delivery teamincluding physical, behavioral health providers, ICT, and discharge plannersto coordinate care and community resources for the member to remain in the least restrictive safe environment possible.
Assist members in developing, implementing, and amending a back-up plan for gaps in provider coverage.
Ensure approved support services are being provided as outlined in the plan of care.
Evaluate the effectiveness of the service plan and make appropriate revisions as required per policy, procedures, and state contractual requirements.
Assist members in overcoming obstacles to optimal care through connection with community resources, including communication with providers and formulation of an appropriate action plan.
Document all case management services and interventions in the electronic health record.
Adhere to all company, state, and federal requirements related to privacy practices, HIPAA, and quality performance standards.
Perform other duties as assigned or requested.
Qualifications
Required Qualifications Bachelors degree in Social Work or health, human, or education services and 3 years of experience in long-term care, home health, hospice, public health, or assisted living.
Masters degree in Social Work or health, human, or education services and 1 year of experience in long-term care, home health, hospice, public health, or assisted living.
Registered Nurse or Licensed Practical Nurse and 2 years of experience in long-term care, home health, hospice, public health, or assisted living.
High school degree or equivalent and three years of qualifying experience with case management of the aged, including management of behavioral health conditions, or persons with physical or developmental disabilities, or HIV/AIDS population.
Preferred Qualifications One year in home clinical or case management experience.
Certified Case Manager (CCM).
Licensed Bachelor Social Worker (LBSW).
Licensed Master Social Worker (LMSW).
Licensed Clinical Social Worker (LCSW).
Experience working with HIV/AIDS population.
Experience working with behavioral health population.
Experience working with developmental disabilities population.
Medicare and Medicaid experience.
Managed care experience.
Skills Working flexible hours to meet members needs.
Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook).
Reliable transportation daily to travel within assigned territory.
Ability to meet regulatory deadlines.
Dedicated home work space for business purposes and compliance with telecommuter policies.
Experience in geriatric special needs, behavioral health, home health.
Understanding of the importance of cultural competency in addressing targeted populations.
Experience with electronic documentation system(s).
Experience with cost neutrality and budgeting.
Travel Requirement 25% - 50%
Pay Range $57,700.00 - $107,800.00
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
#J-18808-Ljbffr