Case Manager Long-term Care Delaware (New Castle County and Kent County)

Highmark Health; New York (NY); Hybrid; USD 60,000 - 75,000; Full time

Job summary

A leading healthcare organization is seeking a dedicated care coordinator to manage member care needs across various settings. This full-time role involves frequent travel to provide assessments and coordinate healthcare services, ensuring members receive the support they need. Ideal candidates will have a background in social work or nursing, with strong organizational and communication skills. Join a team that values compassionate care and community support.

Qualifications

• 3 years of relevant experience with Bachelor's degree or 1 year with Master's.
• 2 years of relevant experience as a nurse.

Responsibilities

• Travel to members’ homes and facilities for assessments.
• Coordinate care for members with chronic and complex needs.
• Educate members on healthcare needs and resources.

Skills

Flexible working hours

Proficiency with PC-based documentation tools

Reliable transportation

Ability to meet deadlines

Cultural competency understanding

Cost management and budgeting skills

Education

Bachelor's degree in Social Work

Master’s degree in Social Work

Registered Nurse

High school diploma

Job description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job serves as the single point of contact for members to coordinate all of the member’s care needs across the various service delivery systems and community supports. This is a full-time community-based position requiring frequent travel within the assigned territory in DE. The incumbent will travel to members’ homes, nursing facilities, and other community-based settings for individuals enrolled in DSHP Plus LTSS.

ESSENTIAL RESPONSIBILITIES

1. Travel to members’ homes, nursing facilities, and other community-based settings to complete face-to-face needs assessments and follow-up via telephonic contact, in accordance with guidelines, policies, and procedures.
2. Assess, plan, coordinate, implement, and evaluate care for eligible members with chronic and complex healthcare, social service, and custodial needs in various settings.
3. Coordinate care across the continuum of services, assisting members with physical, behavioral, long-term services and supports (LTSS), social, and psychosocial needs in a safe, least restrictive, and cost-effective manner.
4. Facilitate authorization, coordination, continuity, and appropriateness of care and services in community or HCBS.
5. Manage transitions to alternate care settings, such as hospital to home or nursing facility to community, using an integrated care team.
6. Educate members or caregivers regarding healthcare needs, benefits, resources, and service options, including long-term care community or facility-based services.
7. Provide education, resources, and assistance to help members achieve goals outlined in their care plan and overcome obstacles.
8. Develop a care plan with members or caregivers to identify services that meet specific needs and goals.
9. Identify resources needed for integrated care coordination, including referrals to specialized programs.
10. Collaborate with the healthcare and service delivery team to coordinate care and community resources.
11. Assist members in developing and implementing backup plans for provider coverage gaps.
12. Ensure support services outlined in the care plan are provided.
13. Evaluate service plan effectiveness and revise as needed per policies and contractual requirements.
14. Help members overcome obstacles by connecting with community resources and communicating with providers.
15. Document all case management services and interventions in the electronic health record.
16. Adhere to all privacy, HIPAA, and quality standards.
17. Perform other duties as assigned.

QUALIFICATIONS

Required

• Bachelor's degree in Social Work or related field plus 3 years of relevant experience, OR
• Master’s degree in Social Work or related field plus 1 year of relevant experience, OR
• Registered Nurse or Licensed Practical Nurse plus 2 years of relevant experience, OR
• High school diploma and 3 years of qualifying case management experience.

Preferred

• One year in home clinical or case management experience
• Certifications such as CCM, LBSW, LMSW, LCSW
• Experience with HIV/AIDS, behavioral health, developmental disabilities, Medicare/Medicaid, or managed care.

Skills

• Flexible working hours
• Proficiency with PC-based documentation tools
• Reliable transportation
• Ability to meet deadlines
• Dedicated home workspace and telecommuting compliance
• Experience with geriatric, behavioral health, or home health care
• Cultural competency understanding
• Electronic documentation experience
• Cost management and budgeting skills

Additional Information

Travel requirement: 25% - 50%

Position type: Works from home, occasional travel, physical work site required, lifting up to 50 pounds occasionally.

Disclaimer: The job description indicates the general nature and essential duties but may not include all responsibilities. Compliance with all applicable laws, policies, and confidentiality standards is required.