Health Plan Care Manager, RN/LSW
CommuniCare Health Services
full-time
Posted on:
Location Type: Office
Location: Charleston • Virginia • West Virginia • United States
Visit company websiteExplore more
About the role
- Oversee and coordinate the care of assigned ISNP members, ensuring they receive timely and appropriate care as dictated by the SNP Model of Care.
- Perform initial, annual, transition of care (TOC) and change in condition health risk assessments (HRA) for ISNP care managed caseload.
- Formulate and implement a member centric holistic care plan that addresses identified needs by assessing the member/representative/family needs, issues, resources and care goals; determining and educating on the choices available to the individual member.
- Collaborate with the interdisciplinary team (ICT) which may include Medical Director, PCP, nurse practitioners/physician assistants, pharmacy, dietary, social workers, other clinical and non-clinical disciplines, facility staff, member representatives and family to establish, revise and continuously evaluate the member centric care plan.
Requirements
- Licensed master’s in social work or licensed Registered Nurse (RN) with a minimum of a bachelor’s degree
- Clinicians must be clinically licensed in the State they are managing members or have compact licensure
- Certified Case Management (CCM) certification or willing to obtain within 1 year of hire (company sponsored)
- Active drivers license as this is NOT a remote role and must have reliable transportation to enable face to face visit to members in facilities
- Minimum of 3-5 years in Case/Care Management preferred and/or 5+ years of direct patient care
- Knowledge of value-based care, fee for service and Medicare Advantage/Dual (Medicare/Medicaid), NCQA, HEDIS and basic Utilization Management functions
- Expertise in care coordination for geriatric and high-risk populations
- Ability and experience utilizing a variety of applications and databases to fulfill care management requirements, and documentation. Documentation integrity is taken quite seriously and will be audited on a frequent basis.
Benefits
- Health insurance
- Retirement plans
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
health risk assessmentscare coordinationcase managementholistic care plan formulationdocumentation integrityutilization managementvalue-based careMedicare AdvantageDual (Medicare/Medicaid)HEDIS
Soft Skills
collaborationcommunicationinterpersonal skillsproblem-solvingorganizational skillsmember advocacyeducational skillsteamworkcritical thinkingempathy
Certifications
Licensed Master’s in Social WorkRegistered Nurse (RN)Certified Case Management (CCM)