RN Case Manager I (Diabetes Program)

Community Health Plan of Washington; Seattle (WA); Remote; USD 50,000 - 90,000; Full time

Job summary

Join a forward-thinking organization dedicated to enhancing the lives of its members through effective case management and coordination programs. This role focuses on delivering high-quality care and improving health outcomes for individuals facing complex medical and behavioral challenges. As a Case Manager, you'll work collaboratively within a multidisciplinary team, advocating for members and ensuring access to vital resources. With a strong emphasis on quality of life and cost-effective solutions, this position offers the opportunity to make a significant impact in the community while enjoying a fully remote work environment. If you are passionate about helping others and thrive in a dynamic setting, this is the perfect opportunity for you.

Benefits

401(k) retirement benefits

Medical, dental, vision insurance

17 days of Paid Time Off (PTO)

Monthly stipend for work-from-home expenses

Community service hours

Short and long-term disability insurance

Wellness programs

Paid jury duty

Compassion time

Floating holidays

Qualifications

• Bachelor's degree in nursing or master's in social work preferred.
• 1 year of case management or 3 years of clinical experience required.

Responsibilities

• Perform telephonic case management for members with complex needs.
• Coordinate resources and assess members' health status.

Skills

Analytical Skills

Effective Communication

Organizational Skills

Time Management

Project Management

Flexibility

Education

Bachelor’s degree in nursing

Master’s degree in social work

Tools

Care Management software

Microsoft Office

Job description

This position is fully remote in Washington State only.

Job Summary

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.

The Case Manager level will be determined by the hiring manager based on education, previous experience, and demonstrated leadership skills.

Essential Functions

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.
• Participates in activities that lead to quality patient outcomes through timely, effective, efficient, equitable, and safe care.
• 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.
• Supports compliance with NCQA accreditation standards.
• 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.

Qualifications

Education

• Bachelor’s degree in nursing or master’s degree in social work and/or related behavior health field preferred

Licensure

• Current, unrestricted license in the State of Washington as a registered nurse (RN) required

Experience

• 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
• Minimum three (3) years of clinical experience in an acute care and/or outpatient setting required

Additional Requirements

• Case Management Certification preferred
• Certified Diabetes Care and Education Specialist (CDCES) preferred
• Bilingual abilities preferred
• Managed care (Medicaid and/or Medicare) experience preferred
• Previous experience using Care Management software applications preferred
• Knowledge of, and experience with, community resources preferred
• Complete and successfully pass a criminal background check
• 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

Knowledge, Skills, and Abilities

• Knowledge of Medicare and Medicaid regulations
• Strong analytical skills and the ability to interpret, evaluate and formulate action plans based upon data
• Experience in care management workflow systems
• Effective verbal and written communication skills
• Flexibility and willingness to work in a matrix-management environment
• Demonstrated organizational, time management, and project management skills
• Ability to handle multiple priorities in a fast-paced environment
• Ability to multi-task and deal with complex assignments on a frequent basis
• Demonstrated proficiency and experience with Microsoft Office products
• Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians, allied health care providers, community partners and other staff members
• Ability to work independently
• Ability to present in a group setting
• Willingness to be part of a fast moving, and dynamic clinical development team
• Collaborate with others in a respectful manner
• Perform all functions of the job with accuracy, attention to detail and within established timeframes.
• Meet attendance and punctuality standards
• Demonstrate professional courtesy to others and ability to maintain confidentiality

CHPW OFFERS ROBUST TOTAL REWARDS

The position is FLSA Exempt (salary) and is not eligible for overtime. The position is also eligible for as an annual incentive based on company, department, and individual performance goals. Full and Part - time employees have the option to enroll in medical, dental, vision and voluntary life insurance benefits, and 401(k) retirement benefits effective the 1st of the month following or coinciding with their start date. CHPW provides a 6% 401(k) employer match, Basic Life, Accidental Death and Dismemberment insurance, short and long-term disability, financial coaching, and wellness programs at no cost.

CHPW employees start earning 17 days of Paid Time Off (PTO) and receive 40 hours of community service for volunteer time, and two floating holidays immediately. The company offers 10 standard holidays, paid jury duty and compassion time.

CHPW offers a monthly stipend to offset work-from-home expenses for roles that are 100% remote.

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Frequent torso/back static position; occasional stooping, bending and twisting
• Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching

Mental:

• Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

WORK ENVIRONMENT

Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.

PROTECTED HEALTH INFORMATION (PHI) ACCESS

All information (written, verbal, electronic, etc.) that an employee encounters while working at CHPW is considered confidential. CHPW employees may encounter protected health information in the regular course of their work at and for CHPW. This position may be exposed to and required to deal with highly confidential and sensitive material and must adhere to CHPW policies, guidelines, and all applicable laws and regulations at all times.

*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.

This job description is intended to describe the general content and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities or requirements of this position.

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.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they