Community Engagement and Complex Case Manager I - Thurston/Mason and Great Rivers Region

Working Each Day to Make a Difference

At Community Health Plan of Washington, we’re driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

We are a local not-for-profit health plan in Washington State.
We are committed to keeping Washington families healthy.
We connect our communities to the health resources they need.
We provide access to high-quality care for our members.
We connect and empower our members through technology.
The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org.



Community Engagement and Complex Case Manager I - Thurston/Mason and Great Rivers Region
This position is a hybrid of remote from home and field work. The candidate will need to reside in and travel throughout Thurston and Mason counties, and the Great Rivers Region (Grays Harbor, Pacific, Lewis, and Cowlitz counties)


POSITION PURPOSE:

This position works under the general direction of the Manager of Case Management and is responsible for the the plan’s regional care management coordination programs and processes. The Regional Case Manager will provide case management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness. This role also provides case management services for CHPW members with highly complex medical/behavioral and social conditions where advocacy and coordination are required. This role represents CHPW during regional meetings regarding care management / care coordination, including presenting / speaking at these meetings. The Regional Case Manager coordinates with the CHPW Regional Manager to provide external representation at community and program-based meetings and initiatives.

PRINCIPAL DUTIES:

Coordinate all case management services within assigned areas in order to assure appropriate coordination of services to CHPW members.
Perform the primary functions of assessment, planning, facilitation and advocacy through collaboration with the member and other health care resources involved in the member's care.
Representation of CHPW Care Management Department at regional meetings
Research meeting agenda and planned topics for effective representation.
Effectively prepare and design presentations for regional meetings
Present information on Care Management programs to regional stakeholders, and brings back information to CHPW
Collaborate with HSD / CHPW leadership for presentation preparation
Follow up with appropriate department leadership for any commitments / requests that came from meetings
Work with providers (specialists, CHC, community resources) and vendors to implement programs and monitor health outcomes of case managed members (both complex and non-complex).
Responsible for assessment (HRA) review of members assigned and appropriateness of the level of care and treatment and participate in clinical outcome data collection. Perform other pertinent condition specific assessments as indicated
Develop member interdisciplinary care plans in conjunction with the member's PCP, specialists, and community resources/vendors..
Coordinate with family and caregivers as appropriate.
Coordinate the interdisciplinary/integrated approach to providing continuity of care including, working with the utilization management, TOC teams to assist in transfer coordination, and discharge planning, whenever applicable.
Maintain case management records within the Jiva system.
Exempt – Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

QUALIFICATIONS:

Education & Prior Related Experience:

Possess a bachelor’s degree in nursing or a master’s degree in social work and/or a related behavior health field (required)
Have a current, unrestricted license in the state of Washington as a registered nurse (RN) (required) OR
Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required) OR
Current, unrestricted license in the State of Washington as a Mental health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required)
Have a minimum of one (1) year of case management experience (required)
Have a minimum of two (2) years of experience in use of care management workflow systems; NCQA standards; and experience meeting with, and presenting to, organizations (required)

Preferred

Have a case management certification
Are bilingual
Have experience in managed care (Medicaid/HCA)
Have previous experience in using Care Management software applications
Have knowledge of, and experience with, community resources

Employment Eligibility:

Candidate has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

Knowledge, Skills, and Abilities:

Knowledge of regulatory and certification requirements and their impact on the organization such as CMS, HCA, HEDIS, CAHPS, and NCQA.
Strong analytical skills and the ability to interpret, evaluate and formulate action plans based upon data
Experience in care management workflow systems
Strong organizational, time management, and project management skills
Ability to handle multiple priorities
Ability to multi-task and deal with complex assignments on a frequent basis
Proficiency and experience with Microsoft Office products
Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers
Ability to work independently
Comfortable presenting in a group setting
Perform all functions of the job with accuracy, attention to detail and within established timeframes.
Meet attendance and punctuality standards
Demonstrate professional courtesy to others and ability to maintain confidentiality
Knowledge of and experience with community and other resources

To apply, please visit: