What are the responsibilities and job description for the Case Manager I (65194) position at Professional Management Enterprises?
Case Manager Iwork with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care for members with high need potential. Qualified candidates MUST live in the state of NEW MEXICO. Specifically visiting members in Bernalillo, Valencia, Sandova County in New Mexico The work schedule is M-F, 8am-5pm MST.
SUMMARY
REQUIRED EDUCATION:
Bachelor's or Master's Degree (preferably in a social science, psychology, gerontology, public health or social work or related)
REQUIRED EXPERIENCE:
1-2 years in case management, disease management, managed care or medical or behavioral health settings.
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
SUMMARY
- Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers from the assessment.
- Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member's needs and goals.
- Conducts telephonic, face-to-face or home visits as required.
- Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
- Maintains ongoing member case load for regular outreach and management.
- Promotes integration of services for members including behavioral health care and long term services and supports to enhance the continuity of care for members.
- May implement specific wellness programs i.e. asthma and depression disease management.
- Facilitates interdisciplinary care team meetings and informal ICT collaboration.
- Uses motivational interviewing and clinical guideposts to educate, support and motivate change during member contacts.
- Assesses barriers to care, provides care coordination and assistance to members to address concerns.
- Collaborates with RN case managers/supervisors as needed or required
- Case managers in Behavioral Health and Social Science fields may provide consultation, resources and recommendations to peers as needed.
REQUIRED EDUCATION:
Bachelor's or Master's Degree (preferably in a social science, psychology, gerontology, public health or social work or related)
REQUIRED EXPERIENCE:
1-2 years in case management, disease management, managed care or medical or behavioral health settings.
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
