Medical Case Manager - (Bilingual- English & Spanish or Creole)

Essential Job Responsibilities

Medical Caseload Management:

Provides outreach and enrollment assistance activities and facilitates enrollment of eligible health center patients and service area residents into affordable health insurance coverage through the Health Insurance Marketplaces, Medicaid, or the Children’s Health Insurance Program.

Interaction with clients that leads to improved client health.

Creates rapport within client interaction in order to help each progress in their medical treatment.

Interviews prospective clients to determine individual needs and eligibility for various medical and social services; enrolling them into available community programs.

Coordinates support and follow-up on medical treatments.

Maintains an average annual active caseload as assigned by the supervisor. 

Serves as a liaison, coordinator and/or advocate between various co-workers within the Case Management, Medical Care departments, or other community medical or agency service providers in order to remove barriers to treatment/care for clients.

Uses knowledge of individual programs to conduct home visits, hospital visits, and one visit with the State of Florida’s contracted disease management firm to develop acuity level of care as needed 

Coordinates with physicians for appropriate service mobilization. 

Discharge planning from hospitalizations that coordinates post-hospital care based upon client needs.

Maintains organized system of tracking client lab, medication, diagnostic testing, medical, therapy, and hospital visits to help clients remain compliant with treatment and service plans; all with the goal of seeing clients progress toward improvements in their lives.

Provides ongoing medication and treatment counseling through the use of treatment adherence assessment tools.

Treatment and Service Planning and Documentation:

Ensures all documentation is Timely, Accurate, Legible, and Clear.

Develops comprehensive, individualized service plans or plans of care.

Monitors clients to assess the efficacy of treatment plans and re-assesses and adjust as necessary.

Empowers clients to participate in their treatment planning.

Maintains treatment plans, progress notes, and progress reviews in client records as specified in agency policy, program guidelines, and performance standards.

Inputs client information using electronic data entry according to agency and departmental guidelines.

Maintains an accurate record on timesheet reflecting time spent in each program worked (e.g. Ryan White 75 hrs, FQHC 5 hrs, ACA 10 hrs ).

Prepares necessary program reports and records as requested by the supervisor and/or manager.

Coordinates with supervisor when necessary to meet unusual challenges.

Manages Resources:

Maintains comprehensive knowledge of community services in order to apply knowledge of services to individual client needs.

Utilizes knowledge of community programs to help clients understand the different types of medical, insurance, and other programs offered under State and Federal Programs as required.

Bills a minimum of six hours in an 8 hour day

Uses program knowledge to provide clients with information about bill-coverage, services and procedures as required. 

Controls, manages and balances, on a monthly basis, the annual budget stipulated by State of Florida for each appropriate client.

Supports billing through concurrent documentation of service provided and budget activities as required (i.e. reconciling billing across data systems including: PCIS, Web-based systems, PROVIDE ENTERPRISE and client records).

Participates in staff training sessions within the timeframes specified and as required by the agency and the funding source.

Community Involvement: 

Participates in agency developmental activities as requested.

Other duties as assigned.

Education: 

Bachelor’s Degree in a behavioral science field like Social Work, Nursing or Psychology is required.

Culture of Service: 3 C’s

Compassion

• Greets internal or external customers (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language.

• Listens to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring and understanding of the request and providing appropriate options or resolutions.

Competency

• Provides services required by following established protocols and when needed, procuring additional help to answer questions to ensure appropriate services are delivered

Commitment

• Takes initiative and anticipates internal or external customer needs by engaging them in the process and following up as needed

• Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure the prompt and effective response is provided

Safety

Ensures proper hand-washing according to the Centers for Disease Control and Prevention guidelines.

Understands and appropriately acts upon the assigned role in Emergency Code System.

Understands and performs assigned roles in the organization’s Continuity of Operations Plan (COOP).

Contact Responsibility

The responsibility for internal and external contacts is frequent and important.

Physical Requirements

This work requires the following physical activities: constant sitting, walking, hearing, talking in person, and talking on the phone. Occasional driving stretching/reaching and standing are required. Work is performed in an office setting. Sometimes, work is performed in clients’ homes, community agency settings, and in hospitals.  

Other

Participates in health center developmental activities as requested. Other duties as assigned. Own transportation required.