- Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
- Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
- Conducts face-to-face or home visits as required.
- Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
- Maintains ongoing member case load for regular outreach and management.
- Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members.
- Facilitates interdisciplinary care team meetings and informal ICT collaboration.
- Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
- Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
- 25- 40% local travel required.
- RNs provide consultation, recommendations and education as appropriate to non-RN case managers.
- RNs are assigned cases with members who have complex medical conditions and medication regimens
- RNs conduct medication reconciliation when needed.
- RN Licensure or LCSW Preferred
- Must have a bachelor's degree in human services or social services field
- Must have 1-3+ years of experience in case management
- Must have a valid driver's license with a good driving record and be able to drive within applicable state or locality with reliable transportation.
- Knowledge of the health and wellness marketplace and employer trends.
- Verbal and written communication skills including discussing medical needs with members and interfacing with internal staff/management and external vendors and community resources.
- Analytical experience including medical data analysis.
- Current driver's license, transportation and applicable insurance.
- Ability and willingness to travel within assigned territory.
- PC proficiency to include Word, Excel, and PowerPoint, database experience and Web based applications.
- Must be able to to lift at least 30lbs
- Must be able to stand or sit for prolonged periods (75% of the time)
- Private Secured Internet Connection
- Must confirm work environment is safe and secure for work in handling private and sensitive information.
- Constantly operates a computer and other office equipment
- Constantly works indoors in a secluded safe space
- Must have High-speed internet access 25 MBPS minimum; 50 MBPS minimum preferred
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Case Manager - Naples, United States - AltaStaff
Description
AltaStaff is a staffing agency currently looking for a Case Manager to work with our Managed Care Client
We are currently hiring for the Naples, FL area
Pay Rate: $28.00 -$33.00 hourly ($34-$39 hourly for Licensed candidates)
Shift: Monday - Friday 8:30am - 5:30pm EST
***This is a Hybrid position, some field work is required.***
*** Mileage Reimbursement Offered ***
Summary: Case Managers works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service
Responsibilities:
INDHP