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 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 to complete face‑to‑face needs assessments and follow‑up telephonic contact in accordance with state and national regulations. Assess, plan, coordinate, implement, and evaluate care for eligible members with chronic and complex health, social, and custodial needs in nursing facilities, homes, or community settings. Coordinate care across the continuum of services and assist members with physical, behavioral, long‑term services and supports (LTSS), social, and psychosocial needs in the safest, least restrictive manner while considering cost‑effectiveness. Authorize LTSS services upon completion of comprehensive needs assessments and coordinate HCBS services, Medicaid, and DSNP benefits. Facilitate transitions to alternate care settings (e.g., hospital to home, nursing facility to community) using an integrated care team. Educate members or caregivers about health care needs, available benefits, resources, and options for long‑term care. Provide resources and assistance to help members achieve plan‑of‑care goals and overcome obstacles to optimal care. Develop individualized care plans with members or caregivers to identify necessary services and goals. Identify resources and facilitate 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 to coordinate care and community resources, maintaining members in the least restrictive safe environment. Assist members in developing, implementing, and amending backup plans for gaps in provider coverage. Ensure approved support services are delivered as outlined in the plan of care. Evaluate the effectiveness of the service plan and make appropriate revisions as needed in accordance with policy, procedures, and state contractual requirements. Assist members in overcoming care obstacles through connection with community resources, provider communication, and action planning. Document all case‑management services and interventions in the electronic health record. Adhere to all company, state, and federal privacy requirements, HIPAA, and quality performance standards. Perform other duties as assigned or requested. Qualifications Required : Bachelor’s degree in Social Work or related health, human, or education services field with 3 years of experience in long‑term care, home health, hospice, public health, or assisted living; OR Master’s degree in Social Work or related health, human, or education services field with 1 year of similar experience; OR Current state RN or LPN license or multi‑state licensure through the enhanced Nurse Licensure Compact (eNLC) with 2 years of experience in long‑term care, home health, hospice, public health, or assisted living; OR High‑school degree or equivalent with three years of qualifying experience in case management of the aged, including management of behavioral health conditions or populations with physical, developmental disabilities, or HIV/AIDS. Preferred One year of home clinical or case management experience Certified Case Manager (CCM) Licensed Bachelors Social Worker (LBSW) Licensed Masters Social Worker (LMSW) Licensed Clinical Social Worker (LCSW) Experience with HIV/AIDS, behavioral health, and developmental disabilities populations Medicare and Medicaid experience Managed care experience Skills Flexible work hours to meet member needs Proficiency in PC‑based word processing and database documentation (Word, Excel, Internet, Outlook) Reliable daily transportation within the assigned territory Ability to meet regulatory deadlines Dedicated home workspace that complies with telecommuter policies Experience in geriatric special needs, behavioral health, or home health Understanding of cultural competency across targeted populations Experience with electronic documentation systems Understanding of cost neutrality and budgeting Language (Other Than English) None Travel Requirement 25% – 50% Physical, Mental Demands and Working Conditions Work primarily out‑of‑the‑office; occasional travel to various sites; occasional lifting up to 25 pounds; occasional heavy lifting up to 50 pounds. Equal Employment Opportunity 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 Highmark