Job Title: Case Manager I
Location: Cincinnati, OH
Duration: 3 Months
Summary : Case Manager develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs. Performs ongoing monitoring of the plan of care to evaluate effectiveness and suggests changes accordingly. Conducts face to face or home visits as required. Experience with Waiver or Passport is Highly preferred. .
Responsibilities:
- Responsible for health care management and coordination of *** members in order to achieve optimal clinical, financial and quality of life outcomes.
- Works with members to create and implement an integrated collaborative plan of care.
- Coordinates 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.
- Proactively identifies members that may qualify for potential case management services.
- Conducts assessment of member needs by collecting in-depth information from Clients information system, the member, members family/caregiver, hospital staff, physicians and other providers.
- Identifies, assesses and manages members per established criteria.
- Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
- Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Client members.
- Conducts face to face or home visits as required.
- Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth. Complies with required workplace safety standards
Education:
- Bachelors degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).
- Required Licensure/Certification: Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing.
Requirements:
- Knowledge of ICD-9, CPT coding and HCPC. SSI, Coordination of benefits, and Third Party Liability programs and integration.
- Familiarity with NCQA standards, state/federal regulations and measurement techniques.
- In depth knowledge of CCA and/or other Case Management tools. Ability to take initiative and see tasks to completion.
- Required Experience: 0-2 years of clinical experience with case management experience.
- Required Licensure/Certification: 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.
- Must have valid drivers license with good driving record and be able to drive locally.
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Company:CONFIDENTIALLocation:Cincinnati - Ohio - United StatesJob Types:ContractPost Date:November 4, 2021Valid Through:December 3, 2021