Case Manager I, MSW/RN

This is a fully remote position, open to applicants in Washington.

📋 Description

• Accountable for the successful execution of the plan's case management and coordination programs and processes.

• Delivers case management services for CHPW members experiencing short-term, long-term, stable, unstable, and predictable illness courses, as well as those with highly complex medical/behavioral and social conditions.

• Aims to enhance members' quality of life and ensure cost-effective outcomes by leveraging both internal and community-based resources.

• The level of Case Manager will be determined by the hiring manager based on educational background, prior experience, and demonstrated leadership abilities.

• Advocates for members and facilitates the coordination of necessary resources to help them achieve optimal functional levels and autonomy within the limitations of their health conditions.

• Collaborates within a multi-disciplinary team to connect with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs, and guarantee access to appropriate services for positive health outcomes.

• Evaluates, plans, implements, and documents member care within the organization's clinical database system, adhering to organizational policies and procedures.

• Responsible for assessing members, including identifying and coordinating access to the appropriate level of care and treatment.

• Utilizes assessment data to determine the appropriate risk and complexity levels and to create and document a care plan in collaboration with the member, family, and health team input.

• Initiates a personalized care plan based on individual member needs, assessment data, and the medical/behavioral care plan.

• Establishes measurable goals for members in partnership with the patient/family to enhance quality of life.

• Plans care in cooperation with multidisciplinary team members, considering the physical, behavioral, cultural, psychosocial, spiritual, age-specific, and educational needs of the member in the care plan.

• Reviews and updates the care plan with the interdisciplinary care team to reflect evolving member needs based on evaluations and/or reassessments.

• Executes the care plan through direct member care, coordination, and delegation of activities among the healthcare team.

• Ensures continuity of care by clearly and completely communicating the status of members to the healthcare team.

• Engages community resources as needed.

• Conducts interdisciplinary care team meetings with members/families to evaluate the care plan and suggest modifications as necessary.

• Continuously assesses members' progress toward goals, identifies potential barriers to achieving goals and expected outcomes, and collaborates with other healthcare team members.

• Records all case activities using the CHPW care management system, adhering to documentation standards and protocols.

• Collaborates with the Transition of Care (TOC) team when a member is hospitalized.

• Acts as a liaison at various local and statewide meetings and/or workgroups while providing clinical support to providers’ networks to enhance integrated care coordination.

• Identifies barriers to care and assists members and the healthcare team in addressing concerns.

• Implements established workflow activities for designated programs.

• Conducts member case management in various settings, including provider offices, members' homes, inpatient medical or psychiatric hospitals, skilled nursing facilities, adult family homes, or community locations.

• Attends member appointments or care conferences in person in collaboration with the member's care team when necessary.

• This role may involve traveling on behalf of the company and working in the field.

• Employees are expected to adhere to their work schedules, participate in all assigned meetings, and meet established performance and accountability standards.

• Additional duties as assigned.

⛳️ Requirements

• Possess a Bachelor’s degree in nursing, or a master’s degree in social work and/or a related behavioral health field (preferred).

• Hold a current, unrestricted license in the State of Washington as a registered nurse (RN) (required).

• OR hold a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required).

• OR hold a 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 at least one (1) year of case management, home health, or discharge planning experience; or possess a combination of education and experience that meets equivalent requirements.

• OR have a minimum of one (1) year of facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse disorder treatment experience, required; or an equivalent combination of education and experience, including work with children and families.

• Experience working with individuals with disabilities and knowledge of Child and Family Services.

• Have a minimum of three (3) years of clinical experience in an acute care and/or outpatient setting (required).

• Proficient in Microsoft Office products.

• Possess a Case Management Certification (preferred).

• Bilingual abilities are preferred.

🏝️ Benefits

• Medical, Prescription, Dental, and Vision insurance.

• Access to a Telehealth app.

• Flexible Spending Accounts and Health Savings Accounts.

• Basic Life AD&D, Short and Long-Term Disability coverage.

• Voluntary Life, Critical Care, and Long-Term Care Insurance options.

• 401(k) Retirement plan with a generous employer match.

• Employee Assistance Program and Mental Fitness app access.

• Financial Coaching and Identity Theft Protection services.

• Paid time off starting at 17 days per year.

• 40 hours of Community Service volunteer time.

• 10 standard holidays and 2 floating holidays.

• Compassionate leave and jury duty leave.