This position is available Remotely in Washington State.

Job Summary

Assists with and coordinates case management activities under the direction of an RN or LICSW Case Manager, Supervisor, or Manager. Functions as an interdependent team member in the areas of member assessment, planning, facilitation, and advocacy. The goal is to improve member quality of life and ensure cost-effective outcomes by using internal and community-based resources.

Essential Functions

• Communicates with providers to arrange follow up appointments, obtain clinical records, and assist members with care coordination
• Ensures appropriate coordination of services to members such as any necessary member transportation needs, obtaining community resources such as food pantries and housing.
• Utilizing critical thinking to problem solve in the removal of barriers or access to appropriate care for members.
• Collaborates with other team members and departments to provide members, and member families, all necessary education and resources as part of their case management plan.
• Coordinates and facilitates services with physical and behavior health care providers within an episode of care.
• Documents and manages the case management process to include case identification, assessment, planning and goal prioritization, monitoring, support, and case closure.
• Participates in clinical outcome data monitoring and collection.
• Assess member health care status and health (medical, behavioral and social) history, risks, gaps and utilization.
• Ability to develop a plan of care with appropriate member centric interventions.
• Ability to provide behavioral health support and interventions to members in crisis.
• Collaborates with member PCP, specialists and community resources/vendors to leverage community resources
• Ensures all care coordination activities are included in the medical record system per established guidelines.
• Prioritize, organize, and complete daily work independently.
• Ability to work with other support staff in answering member calls including participation in the 5pm call rotation for crisis calls.
• Reporting to work on time and for all scheduled shifts is essential to this position.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Qualifications

Education

• Bachelor’s degree in social work, Practical Nursing Certificate, or an equivalent bachelor’s degree in a relevant health care field.
• Candidates with a bachelor’s degrees in a relevant health care field must have a minimum of 1 year experience in care coordination or case management either in a managed care organization, community-based organization, or related workplace.

License, Certifications, and other Specialized Training

• Previous experience as a medical assistant, behavior health technician, or other social welfare services or an equivalent combination of education and highly relevant experience preferred or valid Washington State Licensed Practical Nurse (LPN).

Additional Requirements

• Knowledge of Medicare and Medicaid regulations
• Supports compliance with NCQA and other identified accreditation standards
• Demonstrated understanding of health care systems, regulations, policies, functions, and documentation standards
• Ability to multi-task assignments on a frequent basis
• Knowledge of medical terminology, electronic medical records, developmental disability services, special education IDEA/ADA and healthcare process preferred
• Knowledge of case management systems and planning techniques

Experience

• Minimum of one (1) year of clinical and/or case management experience required
• One (1) year in case management in a health plan, community agency or Accountable Care Organization (ACO) preferred.
• Experience in care management workflow systems.

Employment Eligibility

• Complete and successfully pass a criminal background check
• 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

Knowledge, Skills, and Abilities

• Experience in care management workflow systems
• Effective verbal and written communication skills
• Flexibility and willingness to work in a matrix-management environment
• Demonstrated organizational, time management, and project management skills
• Ability to handle multiple priorities in a fast-paced environment
  • Ability to multi-task
• Demonstrated proficiency and experience with Microsoft Office products
• Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers
• Ability to work independently
• Ability to present in a group setting
• Willingness to be part of a fast moving, and dynamic clinical development team
  • Collaborate with others in a respectful manner
• Perform all functions of the job with accuracy, attention to detail and within established timeframes.
  • Meet attendance and punctuality standards
• Demonstrate professional courtesy to others and ability to maintain confidentiality

CHPW OFFERS ROBUST TOTAL REWARDS

The position is FLSA Non-Exempt (hourly) and is eligible for overtime. The position is also eligible for as an annual incentive based on company, department, and individual performance goals. Full and Part - time employees have the option to enroll in medical, dental, vision and voluntary life insurance benefits, and 401(k) retirement benefits effective the 1st of the month following or coinciding with their start date. CHPW provides a 6% 401(k) employer match, Basic Life, Accidental Death and Dismemberment insurance, short and long-term disability, financial coaching, and wellness programs at no cost.

CHPW employees start earning 17 days of Paid Time Off (PTO) and receive 40 hours of community service for volunteer time, and two floating holidays immediately. The company offers 10 standard holidays, paid jury duty and compassion time.

CHPW offers a monthly stipend to offset work-from-home expenses for roles that are 100% remote.

Member-facing roles are eligible for an hourly premium for multi-language employees who are required to use their language skills in their job and successfully complete a language assessment.

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
• Frequent torso/back static position; occasional stooping, bending and twisting
• Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching

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 with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.

PROTECTED HEALTH INFORMATION (PHI) ACCESS

All information (written, verbal, electronic, etc.) that an employee encounters while working at CHPW is considered confidential. CHPW employees may encounter protected health information in the regular course of their work at and for CHPW. This position may be exposed to and required to deal with highly confidential and sensitive material and must adhere to CHPW policies, guidelines, and all applicable laws and regulations at all times.

• 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.

This job description is intended to describe the general content 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.

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.

Behaviors

• Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
• Team Player: Works well as a member of a group
• Dedicated: Devoted to a task or purpose with loyalty or integrity

Motivations

• Self-Starter: Inspired to perform without outside help

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)