Case Manager I (MSW/RN) Medicare/DSNP

Community Health Plan of Washington; Seattle (WA); On-site; USD 75,000 - 110,000; Full time

Job summary

Community Health Plan of Washington seeks a Case Manager I to oversee telephonic case management for members with diverse needs. You will assess clinical, behavioral, and social determinants to develop tailored care plans and coordinate services across providers and community resources.

Ideal candidates have a WA-licensed RN or Social Worker credential, 1+ year CM/home health experience, and 3+ years clinical background in acute or outpatient settings.

Qualifications

• Master's in social work or BS in nursing; WA licensure as RN or Social Worker required.
• At least 1 year of case management, home health, or discharge planning experience.
• At least 3 years clinical experience in acute or outpatient settings.
• Experience with Microsoft Office products.
• Case Management Certification preferred; bilingual abilities preferred.

Responsibilities

• Conduct telephonic case management for members with acute, chronic, and complex needs.
• Perform comprehensive assessments across clinical, psychosocial, and social determinants.
• Develop and monitor individualized care plans with members and interdisciplinary team.
• Coordinate care across providers, community resources, and internal teams for continuity.
• Advocate for members and address barriers to care and access.
• Document assessments, plans, interventions, and progress in the care management system.

Skills

Case management

Microsoft Office

Independent work

Group presentation

Education

Master’s degree in social work

Bachelor’s degree in nursing

Tools

Care Management software

Job description

** Priority will be given to Washington State Residents**

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to a pply an equity lens to all our work.
• Create an equitable work environment.

About the Role

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 byusing internal and community-based resources.

To be successful in this role, you:

• Have a master’s degree in social work (required for social workers) or a bachelor’s degree in nursing (preferred for nurses).
• Possess a current, unrestricted license in the State of Washington as a Registered Nurse (RN), or Social Worker (LSWAA, LASW, LSWAIC, LICSW), required.
• Have a 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.
• Have a minimum of one (1) year behavioral health experience and/or outpatient psychiatric and substance abuse/substance abuse disorder treatment experience, preferred.
• Have a minimum of three (3) years of clinical experience in an acute care and/or outpatient setting, required.
• Have experience and proficiency with Microsoft Office products.
• Possess a Case Management Certification, preferred.
• Have Bilingual abilities, preferred.

Essential functions and Roles and Responsibilities:

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

• Conducts comprehensive member assessments to identify clinical, behavioral, psychosocial, cultural, educational, and social determinants of health needs; determines risk and complexity levels; and identifies appropriate services, supports, and resources.
• Develops, implements, monitors, and updates individualized care plans in collaboration with members, caregivers, providers, and the interdisciplinary care team to support health outcomes, self‑management, autonomy, and quality of life.
• Coordinates care across providers, caregivers, community resources, contracted vendors, health plan partners, and internal teams to ensure access to appropriate services, continuity of care, and effective transitions between care settings.
• Advocates on behalf of members, identifies and addresses barriers to care, and facilitates access to services, treatments, and community resources to help members achieve optimal health and functional outcomes.
• Monitors member progress toward established goals, evaluates outcomes, and collaborates with members and the interdisciplinary care team to modify interventions and care plans as needed.
• Participates in interdisciplinary care team activities, including care conferences and care coordination meetings, to support integrated, member-centered care planning and service delivery.
• Documents assessments, care plans, interventions, member progress, and all case management activities in the care management system in accordance with organizational policies, regulatory requirements, and documentation standards.
• Implements care management programs, workflows, and quality initiatives while collaborating with providers, community partners, and internal stakeholders to support effective care coordination and positive member outcomes.
• Serves as a clinical resource and collaborates with providers, community partners, and internal stakeholders to promote integrated care coordination and support member needs.
• Actively contributes to team success by stepping in to support training, project work, and other departmental priorities as needs arise.
• Performs other duties as assigned. Essential functions listed are not intended to be exhaustive and may be modified at the discretion of the employer.

Knowledge, Skills, and Abilities:

• Skilled in using Care Management software applications.
• Knowledge of local and statewide community resources.
• Knowledge of Medicare and Medicaid regulatory requirements.
• Knowledge of care management workflow systems.
• Effective verbal and written communication skills.
• Exceptional organizational, time management, and project management skills.
• Ability to work independently.
• Comfortable presenting in a group setting.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn’t perfectly check every box in the job description, we encourage you to apply anyway.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case‑by‑case basis considering the risk to