Case Manager Long-term Care - Delaware (Kent, Sussex, New Castle)

JOB SUMMARY This job serves as the single point of contact for members to coordinate all of the member’s care needs across the various service delivery systems and community supports. This is a full-time community-based position requiring frequent travel within the assigned territory in DE. A significant portion of this role involves working directly with members in their homes and also requires providing case management services within nursing facility settings. The incumbent will travel to members’ homes, nursing facilities, and other community-based settings for individuals enrolled in DSHP Plus LTSS and DSNP. ESSENTIAL RESPONSIBILITIES Conduct regular in‑home and nursing facility visits: travel to members’ homes, nursing facilities, and other community‑based settings to complete face‑to‑face needs assessments with subsequent telephonic contact with the member in accordance with state and national guidelines, policies, procedures, and protocols. This includes actively working within the nursing facility environment and participating in NF care plan conferences to ensure member needs are met. Assess, plan, coordinate, implement and evaluate care for eligible members with chronic and complex health care, social service and custodial needs in a nursing facility or home and community‑based care setting. Coordinate care across the continuum of services and assisting members physical, behavioral, long‑term services and supports (LTSS), social, and psychosocial needs in the safest, least restrictive way possible while considering the most cost‑effective way to address those needs. This includes ensuring appropriate care transitions between home, community, and community‑based care settings. Authorize LTSS services based upon completion of a comprehensive needs assessment. Coordinate HCBS services, Medicaid and DSNP benefits and assess appropriateness of care and services in community. Facilitate transitions to alternate care settings such as hospital to home, nursing facility to community setting using an integrated care team to address the member’s specific needs. Educate members or caregivers regarding health care needs, available benefits, resources and services including available options for long‑term care community or facility‑based service delivery. Provide education, resources, and assistance to help members achieve goals as outlined in their plan of care and to overcome obstacles to achieving optimal care in the least restrictive environment. Develop individualized care plans in conjunction with members or caregivers to identify services to meet the member’s specific needs, and goals. Identify resources needed for a fully integrated care coordination approach including facilitating referrals to special programs such as disease/chronic condition management, behavioral health, and complex case management. Collaborate with the member's health care and service delivery team including the physical, behavioral health providers, ICT, and discharge planners, to coordinate the care needs and community resources for the member to maintain the member in the least restrictive safe environment possible. Assist members in developing, implementing and amending a backup plan for gaps in provider coverage. Ensure approved support services are being provided as outlined in the plan of care. Evaluate the effectiveness of the service plan and making appropriate revisions as needed in accordance with policy & procedures and state contractual requirements. Assist members in overcoming obstacles to optimal care through connection with community resources, including communicating with providers and formulating an appropriate action plan. Document all case management services and intervention in the electronic health record. Adhere to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards. Perform other duties as assigned/requested. QUALIFICATIONS REQUIRED Bachelor's degree in Social Work or in health, human, or education services and 3 years of experience in long‑term care, home health, hospice, public health, or assisted living OR Master’s degree in Social Work or in health, human, or education services and 1 year of experience in long‑term care, home health, hospice, public health, or assisted living OR Current State RN or LPN licensure OR Current multi‑state licensure through the enhanced Nurse Licensure Compact (eNLC) and 2 years of experience in long‑term care, home health, hospice, public health, or assisted living OR A high school degree or equivalent and three years of qualifying experience with case management of the aged, including management of behavioral health conditions, or persons with physical or developmental disabilities, or HIV/AIDS population. SUBSTITUTIONS None PREFERRED One year in home clinical or case management experience Certified Case Manager (CCM) Licensed Bachelor's Social Worker (LBSW) Licensed Master's Social Worker (LMSW) Licensed Clinical Social Worker (LCSW) Experience working with HIV/AIDS population Experience working with behavioral health population Experience working with developmental disabilities population Medicare and Medicaid experience Managed care experience SKILLS Working flexible hours to meet member’s needs Proficiency in PC‑based word processing and database documentation (Word, Excel, Internet, Outlook) Reliable transportation daily to be able to travel within assigned territory Ability to meet regulatory deadlines. Has a dedicated home work space used only for business purposes and is able to comply with all telecommuter policies. Experience in geriatric special needs, behavioral health, home health Understanding of the importance of cultural competency in addressing targeted populations. Experience with electronic documentation system(s) Experience with cost neutrality and budgeting LANGUAGE (OTHER THAN ENGLISH) None TRAVEL REQUIREMENT 25% - 50% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type: Works From Home Teaches / trains others regularly: Occasionally Travel regularly from the office to various work sites or from site‑to‑site: Occasionally Works primarily out-of-the office selling products/services (sales employees): Never Physical work site required: Yes Lifting: up to 10 pounds: Constantly Lifting: 10 to 25 pounds: Occasionally Lifting: 25 to 50 pounds: Rarely PAY RANGE Minimum: $72,700.00 Maximum: $116,600.00 EEO STATEMENT Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. #J-18808-Ljbffr