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

Highmark Health; New York (NY); On-site; USD 60,000 - 80,000; 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 position involves frequent travel to assess and coordinate care for individuals with complex health needs, ensuring they receive appropriate support and resources. Ideal candidates will have a relevant degree, experience in case management, and strong communication skills.

Qualifications

• 3 years relevant experience with Bachelor's degree or 1 year with Master's.
• 2 years experience as RN or LPN, or 3 years case management experience.

Responsibilities

• Travel to members’ homes for assessments and care coordination.
• Educate members on health care needs and available resources.
• Document all case management services in electronic health records.

Skills

Cultural Competency

Documentation

Transportation

Deadline Management

Education

Bachelor's degree in Social Work

Master’s degree in health services

High school diploma/equivalent

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 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, followed by telephonic contact, in accordance with guidelines, policies, and procedures.
2. Assess, plan, coordinate, implement, and evaluate care for eligible members with chronic and complex health care, 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 the safest, least restrictive, and most cost-effective manner.
4. Facilitate authorization, coordination, continuity, and appropriateness of care and services in the community or HCBS.
5. Facilitate 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 health care needs, available 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 plans and overcome obstacles to optimal care.
8. Develop a care plan with members or caregivers to identify services that meet their specific needs and goals.
9. Identify resources for integrated care coordination, including referrals to programs like Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
10. Collaborate with the member's healthcare and service delivery team to coordinate care and community resources to maintain the member in the least restrictive environment.
11. Assist members in developing, implementing, and amending backup plans for provider coverage gaps.
12. Ensure support services outlined in the care plan are provided.
13. Evaluate the effectiveness of service plans and revise as needed, complying with policies and contractual requirements.
14. Assist members in overcoming obstacles to care by connecting with community resources and communicating with providers.
15. Document all case management services and interventions in electronic health records.
16. Adhere to all privacy, HIPAA, and quality standards.
17. Perform other duties as assigned.

QUALIFICATIONS

Required

• Bachelor's degree in Social Work, health, human, or education services plus 3 years of relevant experience, or
• Master’s degree in the same fields plus 1 year of experience, or
• Registered Nurse or Licensed Practical Nurse with 2 years of experience, or
• High school diploma/equivalent with 3 years of case management experience with the aged or disabled populations.

Preferred

• One year of home clinical or case management experience
• Certifications like CCM, LBSW, LMSW, LCSW
• Experience with HIV/AIDS, behavioral health, or developmental disabilities populations
• Medicare and Medicaid experience
• Managed care experience

Skills

• Flexible working hours, proficiency in PC-based documentation, reliable transportation, ability to meet deadlines, and understanding of cultural competency.