Case Manager I – MSW/RN, Medicare/DSNP

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

📋 Description

• Accountable for the operational execution of the case management and coordination programs and processes outlined in the plan.

• Delivers case management services to CHPW members experiencing a range of health conditions, including short-term, long-term, stable, unstable, predictable, and complex medical, behavioral, and social issues.

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

• Acts as an advocate for members, facilitating the coordination of necessary resources to help them attain optimal functional levels and autonomy within their health limitations.

• Collaborates with a multi-disciplinary team to engage with providers, members, caregivers, contracted vendors, community resources, and health plan partners to evaluate the member's health status, identify care needs, and ensure access to appropriate services for favorable health outcomes.

• Conducts assessment, evaluation, planning, implementation, and documentation of 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 suitable level of care and treatment.

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

• Initiates a personalized care plan based on the unique needs of the member, 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 collaboration with the multidisciplinary team, considering the physical, behavioral, cultural, psychosocial, spiritual, age-specific, and educational needs of the member.

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

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

• Ensures continuity of care by accurately and thoroughly informing the healthcare team about the status of members receiving care.

• Engages community resources as necessary.

• Leads interdisciplinary care team meetings with the member/family to evaluate care plans and suggest modifications as needed.

• Continuously assesses members’ progress towards goals, identifying potential barriers to achieving targets and expected outcomes in collaboration 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, providing clinical support to the provider network to enhance integrated care coordination.

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

• Implements established workflow activities and designated program tasks.

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

• Attends member appointments or care conferences alongside the member’s care team when necessary.

• This role may require travel on behalf of the Company and fieldwork.

• Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.

• Additional duties may be assigned.

⛳️ Requirements

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

• Must possess a current, unrestricted license in the State of Washington as a registered nurse (RN) (required), OR a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required), OR 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).

• A minimum of one (1) year of experience in case management, home health, or discharge planning; or a combination of education and experience that provides an equivalent background is required; OR a minimum of one (1) year of facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse disorder treatment experience is required; or an equivalent mixture of education and experience working with children and families.

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

• At least 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 coverage.

• Access to a Telehealth app.

• Flexible Spending Accounts and Health Savings Accounts.

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

• 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.

• Financial Coaching and Identity Theft Protection services.

• Paid time off (PTO) accrual starting at 17 days per year.

• 40 hours of Community Service volunteer time.

• 10 standard holidays and 2 floating holidays.

• Compassionate time off and jury duty leave.