Lead Case Manager - San Francisco, CA, United States - Titanium Healthcare

Description

We are a healthcare company that puts heart and compassion above all else. Millions of Americans just aren't getting the medical care they need. For patients that means exceptional support and better care.

For providers it means better support and time to focus on patients, and for partners that means higher quality and lower cost.

The Lead Care Manager (LCM) is a member facing, community-based care management role.

The LCM will be responsible for providing oversight and coordination of all general and pediatric care management services within the Enhanced Care Management (ECM) program.

The ideal candidate will have extensive experience in care management and a passion for providing high-quality care.

Reviews data and interviews potential members and own families to verify eligibility for enrollment in the ECM and completes referral process when necessary.

Responsibleforcoordinating with individuals and/or entitiestoensureaseamless experiencefor thememberand family andnon-duplicationof services.

Oversee provision of ECM services, including the completion of member assessments, development of member Care Management Plans (CMP), provide educational and community resources.

Offerserviceswherethepediatric member lives,seekscare,or finds most easily accessible and within Managed Care Plan (MCP) guidelines and connect member to other community services and supports he/she may need, including transportation.

Partners with healthcare professionals, community and social support services, and other healthcare entities to coordinate care and locate member resources.

Documents evidence of care in the member's EHR record concisely and abides by all deadlines. · Whenever needed, accompany members and families to office visits to serve as an advocate. · Communicates and collaborates with providers and care teams, regarding the members' progress and care needs.
Identifies, coordinates, and follows-up on member referrals to ensure continuity of care, and member needs are being met.
Reassesses care plans to ensure effectiveness in achieving desired outcomes for members and their family.

Investigates and directs members' and families' inquiries or complaints to appropriate staff members and follows up to ensure satisfactory resolution.

Follows established policies and procedures and attends all training.

Maintains knowledge of community services and resources available to the pediatric members including housing resources, financial/income assistance, transportation assistance and food assistance.

Facilitates care transitions between providers, partners, and referral sources and specialty care providers. · Recognizes signs of child abuse and reports appropriately to Children Protective Services.
Understands and abides by all departmental and companywide policies and procedures.
Complies with all safety and injury prevention policies and regulations.

High School Diploma +1 year of experience as a medical assistant, certified nursing assistant, home health, hospice, care management, or any other healthcare field.

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Language:
Fluent in English (written and verbal). Spanish bilingual preferred.

• Competent with computers, email, virtual platforms, MS Excel, MS Word, MS PowerPoint, MS Outlook, and other Microsoft Office based programs.

Ability to work independently and carry out assignments to completion within the parameters of established policies and procedures

Physical demands associated with office work, including but not limited to:
Consistently operating a computer and other office equipment such as a telephone, calculator, copy machine, and printer.
Must be able to move around the office or visit members 25% of the time.
Frequently moving or carrying office equipment weighing up to 15 pounds across offices.
Ability to operate a vehicle and/or travel to meetings and different office locations as required or requested.
~ Travel:

This is a Hybrid role - LCMs are required to travel to their members within their designated assignments when conducting visits with clients in the field.

• Eligible for mileage reimbursement for the use of your vehicle for business-related expenses.

Medical, Dental and Vision Insurance
Flexible Spending Accounts, Health Savings Accounts & Dependent Care Accounts are also available.
Life, AD&D and Short-Term Disability Insurance funded 100% by Titanium Healthcare
Employee Assistance Program
12 Paid Holidays, 3 weeks of all-inclusive PTO per year (accrual begins on the first day of employment) as well as a separate Paid Sick Time balance
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