13 days old

Case Manager - Level 1 (Hybrid - Remote/On Site)

Umpqua Health
Roseburg, OR 97470
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  • Job Code
    154009577
Full Time - Regular
Roseburg, OR, US



POSITION PURPOSE

The Case Manager (CM) - Level 1 is responsible for helping those with chronic illness, mental health issues or life-altering conditions to gain access to rehabilitation programs and other community services. A CM provides support to the Oregon Health Plan (OHP) enrollees and Medicare members. The CM will adhere to regulatory compliance requirements and provide exceptional customer service to all internal and external customers.



ESSENTIAL JOB RESPONSIBILITIES
  • Meets with clients and their families, connecting clients with professional services and maintaining consistent communication, assessing their wellbeing and making changes to treatment plans as needed.
  • Recording clients progress including charting referrals, home visits and other notable interactions.
  • Evaluating clients progress periodically and adjusting as needed to improve outcomes.
  • Follow-up with discharged clients to ensure they were satisfied with services and are still in good physical and mental health.
  • Perform member screenings using a variety of assessment tools, information gathered from interviewing client and/or other professionals and established clinical guidelines to determine the appropriate referral(s).
  • Respond to program inquiries, conduct intakes and assess eligibility for program services as clients prepare to enter services
  • Gather appropriate consents from members to use in gathering information from outside agencies/sources.
  • Conduct needs assessment to ensure access to internal programs as well as outside community partners.
  • Provide care coordination support and coaching for clients, including support for obtaining employment and housing, through resume building, finding employment, and Social Security applications.
  • Coordinate emergency assistance for eligible clients by communicating with clients and vendors, collecting and completing necessary paperwork and vouchers, and submitting requests for Flexible Spending to accounting department; Follow-up with clients as necessary.
  • Provide information and referral services as needed.
  • Meet with clients to provide high-quality and culturally specific assessment, information and referral, readiness mapping for services.
  • Serve as a liaison to agency programs and community partners with the purpose of screening for readiness of financial empowerment services.
  • Assist as necessary with scheduling of services, and contacting community partners, if outside referral is appropriate.
  • Provide outreach services.
  • Participate in trainings and coordination meetings as requested by Supervisor.
  • Identify barriers for a successful care coordination path.
  • Work independently to complete assigned tasks with minimal instruction.
  • Maintain updated knowledge of the Oregon Administrative Rules (OAR) governing OHP. Remains current on Medicare guidelines and the appeals and grievance process and the members rights and responsibilities as stated by the Division of Medical Assistance Program (DMAP aka HSD) Oregon Health Authority (OHA) and Centers for Medicare and Medicaid Services (CMS.)
  • Demonstrates an on-going understanding and current knowledge of benefits for Medicare and Medicaid populations.
  • Actively engage with members meeting them in a variety of locations comfortable to the patient to discuss and assist with care. This may be an in-home visit, or a local community location.
  • Advocate and navigate within the health care system and community to assist the member with care.
  • Maintain electronic records of clients receiving navigation services and document in appropriate systems for notes of coordination and patient needs.
  • Provide support for internal and external reporting.
  • Comply with organizations internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.
  • Other duties and responsibilities as assigned.



GUIDING BEHAVIORS

Accountability

Always demonstrate the highest performance and behavior standards. Share responsibility and expect others to be accountable.

Efficiency

Demonstrate a proactive approach to problem identification and solutions. Be innovative and solutions oriented, improving processes while reducing costs. Demonstrate appropriate time-management skills. Optimize the use of available resources.

Be a Team Player

Support and assist your team members. Be available to help, and learn from your team. Keep an open mind to feedback and earn trust of staff. Identify your teams strength and weakness. Evaluate goals and give a clear understanding of what is expected in achieving those goals.

Integrity

Keep your promises, commitments, and confidences. Be honest and straightforward in communicating and dealing with all issues fairly and consistently. Be a good listener and give appropriate constructive feedback.

Stewardship

Adhere to all state and federal regulations relating to your position including the Health Insurance Portability and Accountability Act (HIPAA), Fraud & Abuse and Occupational Safety and Health Administration (OSHA) laws. Abide by Company policies and procedures at all times.



CHALLENGES
  • Working with a variety of personalities, maintaining a consistent and fair communication style.
  • Satisfying the needs of a fast paced and challenging company.



QUALIFICATIONS

Level 1:
  • Bachelors Degree in behavioral science, social science or related field or a Licensed RN, LCSW, RX, RT or certified CRC, CDMS, MA eligible for CCM certification.
  • A minimum of 12 months full-time CM experience supervised by a CCM or 24 months full-time CM experience, or 12 Months Full-Time supervisory experience of individuals who provide CM services.
  • Must be Eligible to become a Certified Case Manager (CCM) within a year of employment
  • Must be a Certified Community Health Worker (CHW) upon hire.
  • Excellent interpersonal, written and oral communication skills.
  • Prior experience in a customer service and/or clinical setting.
  • Strong knowledge of available community resources.
  • Demonstrated competency working with people from diverse cultures. Ability to assess and treat clients in a culturally competent manner.
  • Knowledge of medical terminology, procedure codes and diagnosis codes.
  • Clinical knowledge of the health or social work needs for the population served.
  • Demonstrate judgment and discretion in dealing with confidential matters.
  • Must be able to organize and prioritize work, be proactive, take initiative, follow through, and simultaneously manage multiple priorities to ensure goals are met in a timely manner. High attention to detail required.
  • Willingness to learn new skills and take on new responsibilities.
  • Strong analytical and strategic problem-solving skills.
  • Ability to work well in team setting, as well as independently, and be flexible and adapt to different dynamics in a fast-paced work environment.
  • Ability to work a flexible schedule, to include some evenings and weekends.
  • Ability to work remotely.
  • Proficiency with MS Office applications such as; Office, Outlook and Excel.
  • Proficiency with basic office equipment skills such as computer keyboarding, copy machines, multiline phone systems, etc.
  • Ability to type at least 45 wpm with a high degree of accuracy.
  • Ability to manage multiple priorities with attention to detail and follow-up.
  • Ability to organize work and remain focused under stressful conditions with critical attention to detail for accuracy and timeliness.
  • Ability to work effectively with a team, other departments, and exercise sound judgment in handling assigned tasks including maintenance of strict confidentiality.
  • Ability to interact effectively and professionally with internal and internal customers.
  • Ability to work overtime, flexible hours, weekends and holidays is required and a condition of employment.
  • Bilingual (Spanish/English) and bi-culturally competent preferred
  • Ability to support organizational and program-specific mission and goals.
  • Satisfactory results from civil, criminal, and motor vehicle background check required
  • Must have a driver's license, access to vehicle and ability to obtain automobile insurance at levels required by agency.



PHYSICAL DEMANDS

Typical office environment requiring standing, sitting, walking, bending, and lifting up to 25 pounds.






PI154009577

Posted: 2021-11-16 Expires: 2021-12-18

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Case Manager - Level 1 (Hybrid - Remote/On Site)

Umpqua Health
Roseburg, OR 97470

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