Highmark Inc.
CaseManagerLongtermCare
“Case Manager Long-term Care at Highmark Inc.. Skills: Case management, Care coordination, Needs assessment, Care planning. Serve as single point of contact for members' care needs. Coordinate care across service delivery systems”
What You'll Achieve.
Ensure member needs are met; Address member needs in the safest, least restrictive way possible; Address needs in the most cost-effective way; Maintain the member in the least restrictive safe environment possible; Achieve goals as outlined in their plan of care; Overcome obstacles to achieving optimal care; Meet regulatory deadlines; Comply with all company, State and Federal requirements; Comply with privacy practices, HIPAA; Comply with quality performance standards
Industry & Context.
Assist members in overcoming obstacles to optimal care
Frequent travel within the assigned territory in DE, Working flexible hours to meet member’s needs, Reliable transportation daily to be able to travel within assigned territory, Has a dedicated home work space used only for business purposes, Able to comply with all telecommuter policies, Travel Requirement: 25% - 50%, Works primarily out-of-the office, Lifting: up to 10 pounds Constantly, Lifting: 10 to 25 pounds Occasionally, Lifting: 25 to 50 pounds Rarely
What They're Looking For.
Must Have
Bachelor's degree in Social Work or in health, human, or education services and 3 years of experience in long-term care, home health, hospice, public health, or assisted living OR Master’s degree in Social Work or in health, human, or education services and 1 year of experience in long-term care, home health, hospice, public health, or assisted living OR Current State RN or LPN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) and 2 years of experience in long-term care, home health, hospice, public health, or assisted living OR A high school degree or equivalent and three years of qualifying experience with case management of the aged, including management of behavioral health conditions, or persons with physical or developmental disabilities, or HIV/AIDS population.
Nice to Have
One year in home clinical or case management experience, Certified Case Manager (CCM), Licensed Bachelors Social Worker (LBSW), Licensed Masters Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Experience working with HIV/AIDS population, Experience working with behavioral health population, Experience working with developmental disabilities population, Medicare and Medicaid experience, Managed care experience
What You'll Do.
Serve as single point of contact for members' care needs
Coordinate care across service delivery systems
Conduct regular in-home and nursing facility visits
Complete face to face needs assessments
Participate in NF care plan conferences
Coordinate care across continuum of services
Assist members physical
Ensure appropriate care transitions
Authorize LTSS services
Coordinate HCBS services
Assess appropriateness of care and services
Facilitate transitions to alternate care settings
Educate members or caregivers regarding health care needs
and assistance to members
Develop individualized care plans
Identify resources for integrated care coordination
Facilitate referrals to special programs
Collaborate with member's health care and service delivery team
Assist members in developing back-up plan
Ensure approved support services are provided
Evaluate effectiveness of service plan
Assist members in overcoming obstacles to optimal care
Document all case management services and intervention
State and Federal requirements
Perform other duties as assigned/requested
How You'll Work.
Team & Collaboration
Participate in NF care plan conferences; Collaborate with the member's health care and service delivery team; Work with an integrated care team
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