Case Manager I (MSW/RN) Medicare/DSNP

About this role

This position is remote. We are targeting an individual who lives in the Seattle area and is knowledgeable of the area and its available resources. This is essential in being able to assist our Medicare and Dual Plan members by providing education coordination with care teams and connecting to community-based resources.
**Priority will be given to Washington State Residents**
Who we are
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.
Our commitment is to:

• Strive to apply an equity lens to all our work.

• Reduce health disparities.

• Create an equitable work environment.

About the Role
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.
To be successful in this role, you:

• Have a Bachelor’s degree in nursing, or a master’s degree in social work and/or related behavior health field (preferred)

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

• Current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required), OR

• Current, unrestricted license in the State of Washington as a Mental Health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required)

• Have a 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

• Have a minimum of one (1) year facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse/substance abuse disorder treatment experience, required; or equivalent combination of education and experience and/or working with children and families. Experience with those who have disabilities and knowledge of Child and Families Services

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

• Experience and proficiency with Microsoft Office products

• Possess a Case Management Certification (preferred)

• Have Bilingual abilities (preferred)

Essential functions and Roles and Responsibilities:
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.

• 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.

• Conduct member case management in the field at Provider(s) office, member’s home, inpatient medical or psychiatric hospitals, skilled nursing facilities, adult family homes, or in a community setting.

• Attend member…