Regional Field Case Manager I Southwest Region (MSW/RN)

Job Description

Job Description

This position is a hybrid of remote from home and field work. The candidate will need to reside in and travel throughout the Southwest Region - Clark, Skamania and Klickitat Counties.

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

This position works under the general direction of the Supervisor of Care Management and is responsible for the plan’s regional field care management and coordination programs and processes. The Regional Field Case Manager will provide care management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness. The Regional Field Case Manager resides within the assigned region to effectively coordinate care between members, providers and community resources. This role also provides care management services for CHPW members with highly complex medical/behavioral and social conditions where advocacy and coordination are required. This role represents CHPW in the community to provide education on care management programs and provide in-person support for members. The Regional Field Case Manager coordinates with internal and external partners to support members, providers and initiatives in the assigned region.

To be successful in this role, you:

• Possess a Bachelor’s degree in nursing or a master’s degree in social work and/or a related behavior health field (required).
• Have a current, unrestricted license in the state of Washington as a registered nurse (RN) (required) OR
• Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required) OR
• 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 a minimum of one (1) year case management experience; home health or discharge planning experience; or a combination of education and experience which provides an equivalent background required OR
• Have a minimum of one (1) year in an acute care, facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse disorder treatment experience, required; or equivalent combination of education and experience and/or working with children and families.
• Have experience with those who have disabilities and knowledge of Child and Families Services.
• Have a minimum three (3) years of clinical experience and/or outpatient setting (required).
• Have a valid state issued drivers’ license.

Preferred

• Have a case management certification.
• Are bilingual.
• Have experience in managed care (Medicaid/HCA).
• Have previous experience in using Care Management software applications.
• Have knowledge of, and experience with, community resources.
• Have experience in care management workflow systems.

Essential functions and Roles and Responsibilities:

• Engages with members, providers and agencies in the assigned region to support field care management services.
• Provides face-to-face visits to members where telephonic care management is a barrier, to foster effective participation in the care management program.
• Identify and partner with emergency response services or other programs in a community that support members who are high utilizers of medical/behavioral health services. Field case management can include meeting members in acute care, emergency room, adult family home, Inpatient behavioral health facilities, shelters, community health centers, members home or member preferred location.
• Assesses, evaluates, plans, implements, and documents the care of members within the organizations’ clinical database system in accordance with organizational policies and procedures.
• Implements the plan of care through direct member care, coordination, and delegation of the activities of the health care team. Promotes continuity of care by accurately and completely communicating to health care team the status of members for whom care is provided.
• Evaluates members’ progress towards goals, identify potential barriers, assists members in navigating the healthcare system and expected outcomes in collaboration with member and the interdisciplinary care team.
• Works within the multi-interdisciplinary care team that collaborates with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs and ensure access to appropriate services to achieve positive health outcomes.
• Advocates on behalf of members and facilitates coordination of resources required to help members reach optimum functional levels and autonomy within the constraints of their disease conditions.
• Represents CHPW Care Management Department in the community to provide education on care management programs and collaborate with providers and community partners. Leads regional based projects as assigned
• Participates in external care conferences and other d/c planning activities that may be needed to prevent a readmission as needed.
• Participates in clinical case review with internal interdisciplinary team at Care Management Rounds.
• Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
• This position requires traveling on behalf of the Company and working in the field at least 50% of the time. It is essential that a current driver’s license, proof of insurance and an acceptable driving record are maintained.

Knowledge, Skills, and Abilities:

• Knowledge of regulatory and certification requirements and their impact on the organization such as CMS, HCA, HEDIS, CAHPS, and NCQA.
• Knowledge of and experience with community and other resources
• Analytical skills and the ability to interpret, evaluate and formulate action plans based upon data
• Organizational, time management, and project management skills
• Ability to handle multiple priorities
• Ability to multi-task and deal with complex assignments on a frequent basis
• Proficiency and experience with Microsoft Office products
• Written and verbal communication skills; able to communicate with and collaborate effectively with internal departments, physicians and allied health care providers
• Ability to work independently
• Perform all functions of the job with accuracy, attention to detail and within established timeframes.
• Ability to maintain confidentiality

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
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• 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.

*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.

*The above is intended to describe the general content of and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities, or requirements of this position. Job descriptions may be updated or changed to reflect business needs.