Case Manager I (MSW/RN) Medicare/DSNP

Community Health Plan of Washington

Washington

On-site

USD 75,000 - 105,000

Full time

6 days ago

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Benefits offered by this job

Medical benefits

Telehealth app

FSAs/HSA

Life AD&D & Disability

Voluntary Life & LTC

401(k) match

EAP & Mental Fitness

Paid time off & holidays

Job summary

Community Health Plan of Washington is seeking a qualified Case Manager I to oversee telephonic and field-based case management for members with acute, chronic, and complex needs. You will coordinate with providers, families, and community resources to improve quality of life and cost-effective outcomes.

The role requires WA RN, or WA social work licenses, or WA mental health licenses, plus 1+ year in case management and 3+ years of clinical experience.

Qualifications

Bachelor’s in nursing or master’s in social work preferred.
Current WA license as RN, or WA Social Worker license, or WA mental health license.
1+ year of case management or field experience; or equivalent education.
3+ years clinical experience in acute or outpatient settings.
Experience with Care Management software and Microsoft Office.

Responsibilities

Perform telephonic case management for members with varied health needs.
Collaborate with providers, caregivers, and community resources to coordinate care.
Assess and document care plans in the clinical database per policies.
Develop and revise plans of care with input from patient and care team.
Lead interdisciplinary meetings and communicate status to the care team.
Coordinate access to appropriate care levels and services.
Travel to provider offices, member homes, or facilities as needed.
Adhere to documentation standards and participate in quality initiatives.
Support TOC activities during hospital transitions and discharge planning.
Comply with criminal background checks and organizational policies.

Skills

Care management

Microsoft Office

Communication skills

Independent work

Travel for fieldwork

Care management software

Team collaboration

Client advocacy

Cultural sensitivity

Bilingual abilities

Education

Bachelor’s degree in nursing

Master’s degree in social work

RN license WA (unrestricted)

Social worker license WA (LSW/LSWAIC)

Mental health licensing WA (LMHC/LMHP/LMFT)

Case Management Certification

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 apply 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 by using internal and community-based resources.

To be successful in this role, you:

Have a Bachelor’s degree in nursing, or a master’s degree in social work and/or related behavior health field (preferred)
Possess 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)
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 OR
Have a 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
Have a minimum three (3) years of clinical experience in an acute care and/or outpatient setting (required)
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. 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.
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.
Conduct member case management in the field at Provider(s) office, member’s home, inpatient medical or psychiatric hospitals, skilled nursing facilities, adult family homes, or in a community setting.
Attend member appointments or care conferences in collaboration with the members care team when indicated.
This position may requires traveling on behalf of the Company and working in the field. It is essential that a current driver’s license, proof of insurance and an acceptable driving record are maintained.
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.

Knowledge, Skills, and Abilities:

Managed care (Medicaid and/or Medicare) experience
Previous experience using Care Management software applications
Knowledge of, and experience with, community resources preferred
Knowledge of Medicare and Medicaid regulations
Experience in care management workflow systems
Effective verbal and written communication skills
Effective organizational, time management, and project management skills
Ability to work independently
Comfortable presenting in a group setting
Perform all functions of the job with accuracy, attention to detail and within established timeframes.
Meet attendance and punctuality standards

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 the business, members, and employees.

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
Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors.

CHPW offers the following benefits for Full and Part-time employees and their dependents: