Case Manager Long-term Care - Delaware

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

Must be located in Delaware

This job serves as the single point of contact for members to coordinate all of the member’s care needs across the various service delivery systems and community supports. This is a full time community based position requiring frequent travel within the assigned territory in DE. The incumbent will travel to members’ homes, nursing facilities, and other community based setting for individuals enrolled in DSHP Plus LTSS.

ESSENTIAL RESPONSIBILITIES

• Travel to members’ homes, nursing facilities, and other community based settings in order to complete face to face needs assessments with subsequent telephonic contact with the member in accordance with state and national guidelines, policies, procedures, and protocols.

• Assess, plan, coordinate, implement and evaluate care for eligible members with chronic and complex health care, social service and custodial needs in a nursing facility or home and community-based care setting.

• Coordinate care across the continuum of services and assisting members physical, behavioral, long term services and supports (LTSS), social, and psychosocial needs in the safest, least restrictive way possible while considering the most cost-effective way to address those needs.

• Facilitate authorization, coordination, continuity and appropriateness of care and services in community or HCBS.

• Facilitate transitions to alternate care settings such as hospital to home, nursing facility to community setting using an integrated care team to address the member’s specific needs.

• Educate members or caregivers regarding health care needs, available benefits, resources and services including available options for long term care community or facility-based service delivery.

• Provide education, resources, and assistance to help members achieve goals as outlined in their plan of care and to overcome obstacles to achieving optimal care in the least restrictive environment.

• Develop a plan of care in conjunction with members or caregivers to identify services to meet the member’s specific needs, and goals.

• Identify resources needed for a fully integrated care coordination approach including facilitating referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.

• Collaborate with the member's health care and service delivery team including the DSHP Plus LTSS Member Advocate, ICT, and discharge planners, to coordinate the care needs and community resources for the member in order to maintain the member in the least restrictive safe environment possible.

• Assist members in developing, implementing and amending a back-up plan for gaps in provider coverage.

• Ensure approved support services are being provided as outlined in the plan of care.

• Evaluate the effectiveness of the service plan and making appropriate revisions as needed in accordance with per policy and procedures and state contractual requirements.

• Assist members in overcoming obstacles to optimal care through connection with community resources, including communicating with providers and formulating an appropriate action plan.

• Document all case management services and intervention in the electronic health record.

• Adhere to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards.

• Perform other duties as assigned/requested.

QUALIFICATIONS

Required

• 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

• Registered Nurse or Licensed Practical Nurse 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.

Substitutions

• None

Preferred

• 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

SKILLS

• Working flexible hours to meet member’s needs

• Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)

• Reliable transportation daily to be able to travel within assigned territory

• Ability to meet regulatory deadlines.

• Has a dedicated home work space used only for business purposes and is able to comply with all telecommuter policies.

• Experience in geriatric special needs, behavioral health, home health

• Understanding of the importance of cultural competency in addressing targeted populations.

• Experience with electronic documentation system(s)

• Experience with cost neutrality and budgeting

Language (Other than English):

None

Travel Requirement:

25% - 50%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Works From Home

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$57,700.00

Pay Range Maximum:

$106,700.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J245846

Highmark Health Culture:

Located in the dynamic community of Sunset Valley, TX, Highmark Health is a beacon in the healthcare industry, offering diverse job opportunities for those dedicated to making a difference in healthcare services. As a premier healthcare provider, we are dedicated to excellence and innovation across various healthcare sectors, positioning us as a top choice for professionals seeking healthcare jobs near Sunset Valley, TX. Our mission is to deliver unparalleled healthcare services to our community, a commitment that is at the core of our culture and motivates our ongoing search for passionate individuals to join our team.

Highmark Health has become a key player in the Sunset Valley, TX healthcare landscape, not only by providing exceptional care but also by generating extensive employment opportunities for healthcare professionals. Whether you are a seasoned Case Manager Long-term Care - Delaware or a recent graduate ready to embark on your healthcare career, Highmark Health offers a supportive and dynamic environment where your talents are valued and your professional development is encouraged. With our broad operations in Sunset Valley, TX, we are continually seeking skilled individuals to fill roles in various categories, ensuring a steady demand for healthcare professionals in our community.

Highmark Health is at the forefront of addressing the growing need for quality healthcare in Sunset Valley, TX, offering numerous job openings for those searching for healthcare positions in their vicinity. Our dedication to adopting the latest healthcare technologies and methodologies means our team is ever-expanding, with a keen interest in hiring professionals such as (RN) Case Managers for Assisted Living, Associate Dentists, Clinical Pharmacists, Field Training Audiologists, Occupational Therapists, Social Workers, and Staff Physical Therapists, who are eager to positively impact our patients' lives. Joining Highmark Health places you among a group of dedicated professionals committed to delivering the best healthcare in Sunset Valley, TX, and beyond.

For individuals in Sunset Valley, TX seeking healthcare jobs near them, Highmark Health offers a unique chance to work in a cutting-edge facility that prioritizes both the professional growth of its staff and the health of its patients. We recognize the significance of local employment opportunities in building a strong community and proudly provide a variety of positions that accommodate the diverse expertise within the healthcare field. From clinical roles like (RN) Case Managers, Associate Dentists, and Clinical Pharmacists to specialized positions such as Field Training Audiologists, Occupational Therapists, Social Workers, and Staff Physical Therapists, Highmark Health is eager to attract and retain top talent in and around Sunset Valley, TX.

In conclusion, Highmark Health is more than a leader in healthcare; we are a significant employer in the healthcare sector within Sunset Valley, TX. Our dedication to excellence in healthcare services is paralleled by our commitment to creating job opportunities for those seeking healthcare positions close to home. By choosing to grow your career with Highmark Health, you're not just joining a team of exceptional healthcare professionals; you're also contributing to the well-being of the Sunset Valley, TX community. We invite you to explore the exciting career opportunities at Highmark Health and take the first step toward a rewarding healthcare career, right here in Sunset Valley, TX.

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