What are the responsibilities and job description for the Healthcare Case Manager position at Professional Management Enterprises?
Job Title : Care Coordinator | Case Manager
Location :
Must be an Indiana Resident
Hours : Monday - Friday 8am-5pm
Job Summary :
The Care Coordinator (Case Manager - Nurse or Social Worker) must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC).
Primary Responsibilities :
Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications :
Resident of Indiana
BSN with equivalent experience
Registered Nurse or Social Worker with an unrestricted License in Indiana
Experience working within the community health setting in a health care role
Experience or knowledge of Indiana Medicaid, Medicare, Long term care
Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications :
3 year of case management leadership experience within a healthcare industry
Background in managed care
Case Management experience
Certified Case Manager (CCM)
Experience / exposure with members receiving long term social supports
Experience in utilization review, concurrent review and / or risk management
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