Case Manager I (MSW/RN) Medicare/DSNP

Job Description

Job Description

This position is fully Remote. 

** Priority will be given to Washington State Residents**

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to apply an equity lens to all our work. 
• Reduce health disparities. 
• Create an equitable work environment. 

About the Role

Responsible for the operational delivery of the plan’s case management and coordination programs and processes. Provides case management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness, and/or highly complex medical/behavioral and social conditions. The goal is to improve members' quality of life and ensure cost-effective outcomes by using internal and community-based resources.

To be successful in this role, you:

• Have a master’s degree in social work (required for social workers) or a bachelor’s degree in nursing (preferred for nurses).
• Possess a current, unrestricted license in the State of Washington as a Registered Nurse (RN), or Social Worker (LSWAA, LASW, LSWAIC, LICSW), required.
• Have a minimum of one (1) year case management, home health or discharge planning experience; or a combination of education and experience which provides an equivalent background, required.
• Have a minimum of one (1) year behavioral health experience and/or outpatient psychiatric and substance abuse/substance abuse disorder treatment experience, preferred.
• Have a minimum of three (3) years of clinical experience in an acute care and/or outpatient setting, required.
• Have experience and proficiency with Microsoft Office products.
• Possess a Case Management Certification, preferred.
• Have Bilingual abilities, preferred.

Essential functions and Roles and Responsibilities:

The Case Manager I is responsible for performing telephonic case management for members with acute, chronic, and complex needs.

• Conducts comprehensive member assessments to identify clinical, behavioral, psychosocial, cultural, educational, and social determinants of health needs; determines risk and complexity levels; and identifies appropriate services, supports, and resources.
• Develops, implements, monitors, and updates individualized care plans in collaboration with members, caregivers, providers, and the interdisciplinary care team to support health outcomes, self-management, autonomy, and quality of life.
• Coordinates care across providers, caregivers, community resources, contracted vendors, health plan partners, and internal teams to ensure access to appropriate services, continuity of care, and effective transitions between care settings.
• Advocates on behalf of members, identifies and addresses barriers to care, and facilitates access to services, treatments, and community resources to help members achieve optimal health and functional outcomes.
• Monitors member progress toward established goals, evaluates outcomes, and collaborates with members and the interdisciplinary care team to modify interventions and care plans as needed.
• Participates in interdisciplinary care team activities, including care conferences and care coordination meetings, to support integrated, member-centered care planning and service delivery.
• Documents assessments, care plans, interventions, member progress, and all case management activities in the care management system in accordance with organizational policies, regulatory requirements, and documentation standards.
• Implements care management programs, workflows, and quality initiatives while collaborating with providers, community partners, and internal stakeholders to support effective care coordination and positive member outcomes.
• Serves as a clinical resource and collaborates with providers, community partners, and internal stakeholders to promote integrated care coordination and support member needs.
• Actively contributes to team success by stepping in to support training, project work, and other departmental priorities as needs arise.
• Performs other duties as assigned. Essential functions listed are not intended to be exhaustive and may be modified at the discretion of the employer.

Knowledge, Skills, and Abilities:

• Skilled in using Care Management software applications.
• Knowledge of local and statewide community resources.
• Knowledge of Medicare and Medicaid regulatory requirements.
• Knowledge of care management workflow systems.
• Effective verbal and written communication skills.
• Exceptional organizational, time management, and project management skills.
• Ability to work independently.
• Comfortable presenting in a group setting.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn’t perfectly check every box in the job description, we encourage you to apply anyway.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check

Criminal History:  includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• 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
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors.

CHPW offers the following benefits for Full and Part-time employees and their dependents: 

• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory* :

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical* :

• Extended periods of sitting, computer use, talking, and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion

Mental :

• Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.