Case Manager

Title: Case Manager
Duration: 12 months 
Location: The role is 100% remote, but candidates need to be from an approved conversion State (Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

Job Description:

• Serve as a team member on a multidisciplinary team, coordinating care, resources, and/or services for members to achieve optimal clinical and resource outcomes. 
• Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners, and external services/providers on plans for treatment, appropriate intervention and/or discharge planning.
• Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs; identify barriers to meeting goals or plan of care.
• Utilize community resources and funding sources as needed in the development of the plan of care.
• Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
• Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc).
• Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes.
• Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.  
• May outreach directly to members identified as high risk, high cost, or high utilization cases.
• May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
• May evaluate medical necessity and appropriateness of services as defined by department.
• As needed, develop relevant policies/procedures, education or training for use both internally and externally.

Hiring Requirements:

• RN, RD or LCSW with 3 years of clinical and/or case management experience required. For some roles a Master's in Social Work with 5 years of related experience may be considered.
• For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
• For some roles, additional specialty certification (i.e. CCM, CDCES) may be required.  If so, incumbents must obtain relevant certification within 2 years of employment.

Nice to have Skills:

• Wide range of experience.

Years of Experience:

• 3-5 years of experience.

Education/Certifications Required:

• Compact licensure

Breakdown of Duties/Typical Day:

• Logging in first thing in the morning, looking at emails, reviewing voicemails, getting assignments.
• Making outreach to new members and following up with members that you have previously engaged. During the day you are put into the queue and can potentially get new cases from the call center rotation.
• Be available when members are reaching out to confirm the primary care specialists.
• Talk with the utilization resources.

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 37.63/hr.