Remote Case Manager I (RN) – Patient Review and Coordination program – Washington

Working Each Day to Make a Difference

At Community Health Plan of Washington, we’re driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

• We are a local not-for-profit health plan in Washington State.
• We are committed to keeping Washington families healthy.
• We connect our communities to the health resources they need.
• We provide access to high-quality care for our members.
• We connect and empower our members through technology.
• The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
• Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org.

POSITION PURPOSE:

Responsible for the operational delivery of the plan’s case management and coordination programs and processes. Provides case management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness, and/or highly complex medical/behavioral and social conditions.

The goal is to improve members’ quality of life and ensure cost-effective outcomes by using internal and community-based resources.

The Case Manager level will be determined by the hiring manager based on education, previous experience, and demonstrated leadership skills.

PRINCIPAL DUTIES:

The Case Manager I is responsible for performing telephonic case management for members with acute, chronic, and complex needs.

Examples listed below are not necessarily exhaustive and may be revised by the employer.

• 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.
• Participates in activities that lead to quality patient outcomes through timely, effective, efficient, equitable, and safe care.
• 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.
• Supports compliance with NCQA accreditation standards.
  • 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.

QUALIFICATIONS:

Education:

• Bachelor’s degree in nursing or master’s degree in social work and/or related behavior health field preferred

License:

• Current, unrestricted license in the state of Washington as a registered nurse (RN) required OR
• Current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) required OR
• Current, unrestricted license in the State of Washington as a Mental health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) required.

Prior Related Experience:

• 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 OR
• 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
• Minimum three (3) years of clinical experience in an acute care and/or outpatient setting required.

Additional Requirements:

• Case management certification preferred.
• Bilingual abilities preferred.
• Managed care (Medicaid/HCA) experience preferred.
• Previous experience in using Care Management software applications preferred.
• Knowledge of, and experience with, community resources preferred.

Employment Eligibility:

• 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 Medicare and Medicaid regulations
• Experience with wrap around with intensive services (WISE) and Children’s long term Inpatient program (CLIP)
• Experience with school-based counseling and Individual education plans (IEP)
• Familiar with Applied Behavioral Analysis (ABA) resources and alternative therapies
• 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, allied health care providers, community partners and other staff members.
• 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.

To apply, please visit:  https://www.chpw.org/contact-us/chpw-careers/

We’re committed to our employees and their family, which is why we offer benefits that, makes a difference in their lives. Paid time off, tuition reimbursement, community service hours, and transportation perks are just a few of the offerings of our comprehensive and competitive benefits program.

Community Health Plan of Washington is an Equal Opportunity Employer with a diverse workforce!

Headquarters:              1111 3^rd Avenue, Suite 400 Seattle, WA  98101