MEDICAL CASE MANAGER

JOB SUMMARY

The Medical Case Manager is responsible for coordinating the assessment and subsequent referrals/access to medical, dental, mental health/substance abuse care, pharmaceutical access, treatment education, and other services needed by Care Resource clients. S/he assists with signing up individuals for insurances under the Affordable Care Act’s Insurance Exchanges for the State of Florida, provides education to potentially insured clients and utilizes tools specifically designed to select the best coverage based upon individual’s current medical profile including preferred providers, medications, co-pays, deductibles and premiums.

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 leads to improved client health.
• Creates rapport within client interaction 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 follows 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 provider 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 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 efficacy of treatment plans and re-assesses and adjusts 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.
• Input client information using electronic data entry according to agency and departmental guidelines.
• Maintains an accurate record on time sheet reflecting time spent in each program worked (e.g. Ryan White 75 hrs, Medicaid Waiver 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 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, monthly, the annual budget stipulated by the 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, CASEWATCH 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.

Safety

Ensure proper hand washing according to Centers for Disease Control and Prevention guidelines.

Documents patient’s medications correctly, makes sure each patient knows which medicines to take when they are at home and encourages each

patient to bring their up-to-date list of medicines every time they visit the doctor.

Ensures each new client receives screening for their risk of suicide.

Understands and appropriately acts upon assigned role in Emergency Code System

Understands and performs assigned role in Agency Continuity of Operations Plan (COOP)

JOB SPECIFICATIONS

Education:

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

Training and Experience:

Two years of related experience are required. One year of HIV/AIDS experience is required. HIV/AIDS 104, 500 & 501 and Case Management training provided by the State or County are required within 90 days of hire date.

Licenses and/or certifications:

Affordable Care Act Certified Application Counselor Certificate required annually.  Case Management Medicaid Provider Certification is required. Completed application and fingerprinting submitted to supervisor within 30 days of hire and providership obtained within 90 days of hire if not already Medicaid PAC Waiver Provider. Must score 90% or better on position competencies within 90 days.

Job Knowledge and Skills:

Bilingual (English Spanish/ English-Creole) is preferred. Computer knowledge should include Microsoft Word and Excel. Good organizational and teamwork skills. Excellent communication, decision making and problem-solving skills. Ability to work with multicultural and diverse population is required.

Contact Responsibility:

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

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, procure 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 handwashing 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 usually is performed in an office setting. Sometimes, work is performed in client’s homes, community agency settings and in hospitals.  

Other

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