Case Manager

Case Manager

Under the direction of the Director of Population Health, the Case Manager works as part of the Population Health Team and Clinical Team to assist patients and their families to understand their needs, provide support, and address socioeconomic needs. Case Managers are a vital part of the treatment team whose overall objective is to enhance the quality of patient management, treatment planning, care coordination, and referral management to improve patient outcomes. This goal is achieved by facilitating a smooth and efficient continuity of care for patients while helping the patient meet their health care goals.

This position primarily provides targeted assistance to underserved or vulnerable populations as identified by the Exchange and within the Exchange service area in Aiken County and surrounding counties. The Enrollment Case Manager provides excellent customer service to health or social service agencies in addition to providing health education.

Essential Functions/Responsibilities:

• The Case Manager provides ongoing professional, technical and clinical expertise/support through comprehensive assessment and planning, with a focus on coordination of care and individual patient needs.
• Build trusting relationships with individuals and families; facilitate insurance enrollment; coordinate referrals to medical homes and community resources; and deliver educational programming.
• Cultivate relationships with community partners in Aiken County and surrounding counties in ways that help provide services to targeted client populations.
• Assessing clients' physical and mental wellness and abilities by utilizing appropriate screening tools and communicating the results with the clients' care team to advocate for needed services.
• Monitor, evaluate, and record client progress with respect to treatment goals determined by the provider. Collaborate with counselors, physicians, or nurses to plan or coordinate treatment, drawing on social work experience and patient needs.
• Contact and schedule follow-up appointments for patients who have been discharged from inpatient hospital visits, emergency room/urgent care visits, skilled nursing facilities and inpatient rehabilitation centers.
• Meet face-to-face with each identified hospital, ER, urgent care, etc. follow-up when they present to the clinic to identify current needs that will prevent hospital admissions.
• Follow-up with high-risk patients and post hospital patient visits to reassess needs and response to treatment and for continuity of care.
• Assist Clinical Pharmacist with patient management for high-risk patients who need additional resources, appointments, and tracking.
• Process patient cases and/or referrals sent within the EMR from the Primary Care Provider, Clinical Pharmacist, or clinical staff for patients with identified need requests. Connect patients with professional services and maintain consistent communication with clients to assess their wellbeing and make changes to their treatment plan as needed.
• Complete assigned gap in care rosters by contacting identified patients, scheduling appointments, and notifying the provider of an open gap in care by utilizing documented notification process.
• Complete daily chart preparation for assigned provider and follow-up on the completion of identified gaps in care. Utilize tools provided to track all gaps in care closures.
• Document all daily progress on the Basecamp platform.
• Promote quality and cost-effective interventions and outcomes by assessing the patient's health insurance plan to ensure that the best care is delivered with the least financial burden. Provide education and assistance to clients regarding healthcare coverage in ways that are easy to understand.
• Adhere to professional standards in dress and appearance as outlined by protocols, rules and regulations.
• Perform other related duties as assigned by the Director of Population Health.

Skills/Certifications:

• Knowledge of case management principles, healthcare management and reimbursement; ability to assist in investigative analysis and make effective recommendations as required.
• Demonstrated understanding of healthcare reform changes and the impact on local health care systems and knowledge of healthcare financial assistance programs and resources available to assist low-income, underinsured, or uninsured clients.
• Ability to acquire knowledge of policies, procedures, and programs; comprehend, interpret, and apply basic laws and regulations to specific situations; handle confidential materials with professionalism and discretion.
• Ability to manage time and work under pressure both independently and in a team setting.
• Ability to prepare clear, sound, accurate and informative reports containing findings, conclusions, and recommendations as required. Must be proficient with Microsoft Office (Word, Excel, and PowerPoint).
• Effective communication skills; the ability to relate with warmth and effectiveness to patients and staff; excellent organizational and time management skills.
• Problem solving skills and the ability to prioritize multiple tasks and perform efficiently and effectively in a stressful environment.
• Must complete the HHS-developed training program and pass an exam using the navigator ID number issued by the SCPHCA.
• Must have an appropriate understanding of relevant Exchange related information before assisting consumers with marketplace applications and successfully complete all required and applicable federal and/or state consumer assistance-training opportunities.
• Secures and maintains certification to assist with Medicaid and Marketplace eligibility enrollment rules and procedures, the range of qualified health plan options and insurance affordability programs, and privacy and security standards.
• Maintain proficiency in SC Thrive for enrollment and resource management.
• Must be certified in Basic Life Support Techniques.

Education Recommended:

• Well versed in medical terminology and previous experience working in a health care setting required.
• Successful completion of an associate degree or bachelor's degree in a related health care field from an accredited school.
• At least 2 years of primary care clinic case manager experience preferred.
• Insurance enrollment experience preferred.

Disclaimer:

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive list of activities, duties, or responsibilities required for the incumbent. Incumbents may be asked to perform other duties as required and the responsibilities of the position may change.