Title: Case Manager
Work Schedule: 100% Remote (CST Hours)
License Required: RN, LPN, or LSW (Active in Texas)
Experience: Experience with Geriatric Population (Preferred but not mandatory)
Summary: As a Case Manager at the National Healthcare Organization, your role is to manage and coordinate healthcare services for our members, ensuring they achieve optimal clinical, financial, and quality of life outcomes. You will collaborate with members to create and implement comprehensive care plans, monitor their progress, and ensure that they receive cost-effective care in compliance with all state and federal regulations.
- Identify members who may benefit from case management services proactively.
- Conduct assessments to gather comprehensive information from various sources, including company's information system, members, their families/caregivers, hospital staff, and providers.
- Assess and manage members according to established criteria.
- Develop and implement personalized case management plans in collaboration with members, caregivers, physicians, and other healthcare professionals.
- Continuously monitor and evaluate the effectiveness of care plans and make necessary modifications for optimal outcomes.
- Measure the impact of interventions to assess case management outcomes.
- Promote the integration of services, including behavioral health and long-term care, to enhance continuity of care for our members.
- Maintain productivity and quality standards within the department.
- Successfully manage assigned work plan objectives and projects.
- Demonstrate dependability, reliability, and adherence to documentation guidelines.
- Actively participate in staff meetings and interdisciplinary care team meetings.
- Assist in orienting and mentoring new team members.
- Maintain professional relationships with the provider community and internal/external customers.
- Uphold a professional demeanor at all times.
- Foster cooperative and effective workplace relationships and adhere to the company Code of Conduct.
- Engage in relevant case management conferences to enhance skills and abilities.
- Ensure compliance with workplace safety standards.
- Demonstrated ability to communicate, problem-solve, and collaborate effectively.
- Strong organizational skills, including the ability to manage multiple priorities.
- Proficiency in working independently and handling multiple projects simultaneously.
- Solid analytical skills.
- Knowledge of applicable state and federal regulations.
- Familiarity with ICD-9, CPT coding, HCPC, SSI, Coordination of Benefits, Third-Party Liability programs, and integration.
- Understanding of NCQA standards, state/federal regulations, and measurement techniques.
- In-depth knowledge of CCA and/or other Case Management tools.
- Proactive approach and ability to follow through on tasks.
- Computer literacy and experience with Microsoft Office Products.
- Excellent verbal and written communication skills.
- Compliance with Molina's policies.
- Maintenance of regular attendance based on the agreed schedule.
- Adherence to confidentiality requirements under the Health Insurance Portability and Accountability Act (HIPAA).
- Skill in establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers, and customers.
- Bachelor's degree in Nursing or a Master's degree in Social Work or Health Education. A combination of experience and education will be considered in lieu of a degree.
- 5+ years of clinical experience with case management experience.
- Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker (LCSW) or Advanced Practice Social Worker (APSW) in good standing.
- A combination of experience and education will be considered in lieu of LCSW or APSW.
- CCM highly preferred
Additional Information: This position offers high potential for a temp-to-perm opportunity. If you are a dedicated and skilled healthcare professional with a commitment to ensuring the well-being of our members, we encourage you to apply for this role with the National Healthcare Organization.