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Case Manager (RN or LSW) - Remote/Dayton, OH - 3 Months+
Location: US-CA-Long Beach
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Job Title: Case Manager - (RN, LSW) Dayton, OH area [3 month+ contract] Location: Remote/near Dayton, OH area
Initial Duration: 3 Months+ (extendable) Job Overview: It is remote, once covid restrictions are lifted they would be required to travel to Nursing Facilities in their area. Dayton, Ohio area. Shift: 8-5 EST (flexible) License: Must be RN or LSW, must be comfortable working independently and with computer. Day to day responsibilities will include calling nursing facilities, members, complete assessments and document. Required licensure: RN or LSW Required education: Graduate from an Accredited School of Nursing. Bachelor's Degree in Nursing or Bachelors of Social Work preferred Required Experience: 3-5 years of clinical experience. 1-3 years in case management, disease management, managed care or medical or behavioral health settings. Summary: Responsible for health care management and coordination of Company Healthcare 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 Company member s progress and services to ensure consistent cost-effective care that complies with Company policy and all state and federal regulations and guidelines. Essential Functions: - Provides case management services to members with chronic or complex conditions including:
- Proactively identifies members that may qualify for potential case management services.
- Conducts assessment of member needs by collecting in-depth information from Company s information system, the member, member s 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.
- Performs ongoing monitoring of the plan of care to evaluate effectiveness.
- Documents care plan progress in company's information system.
- Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
- Measures the effectiveness of interventions to determine case management outcomes.
- Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Company members.
- Conducts face to face or home visits as required.
- Participates in Interdisciplinary Care Team (ICT) meetings.
- Assists orientation and mentoring of new team members as appropriate.
- Maintains professional relationships with provider community and internal and external customers.
- Conducts self in a professional manner at all times.
- 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.
Knowledge/Skills/Abilities: Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Strong analytical skills. Knowledge of applicable state, and federal regulations. 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. Computer skills and experience with Microsoft Office Products. Excellent verbal and written communication skills. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. Required 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 Experience: Minimum 1-2 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 driver's license with good driving record and be able to drive locally.
The Structures Company
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