Disability Claims Case Manager Jobs in Colorado (NOW HIRING)

Why work at Rocky Mountain Human Services? 
You will have the opportunity to contribute to an organization that is dedicated to embracing the power of community to support individuals and families in creating their future.

RMHS provides great benefits such as:

• Employer paid medical options, dental, and vision benefits
• Generous paid time off such as vacation, sick, personal, and holidays
• Life and disability insurance
• Tuition reimbursement (full-time employees only)
• Mileage reimbursement
• 403(B) with company match
• Employee assistance program

Position Purpose

Case managers serve as the main contact for members receiving Long Term Services and Supports through Medicaid or State Funded programs. The case manager provides specialized, initial and ongoing case management by monitoring services, having communication with members and providers, and coordinating resources and requests as needed. Case managers serve as the experts in eligibility assessments, service plans, and prior authorization requests (PARs). 

Please see below for the four departments we have available for Case Manager and be prepared to discuss your preferred area.  

Departments

Intake:

The Intake Case Manager helps individuals and members get started with services by completing the initial functional assessment. This is the first eligibility step to see if a person qualifies for long term services and supports. This position helps the member understand the process and steps needed to qualify for services and communicates outcomes related to eligibility. The intake case manager assists the member to determine the best services to meet their individual needs. Intake case management teams include a hospital team, nursing facility team, PACE team, community adult teams for both I/DD and non-IDD, and children's team.

Non IDD:

The non-IDD Case Manager provides ongoing care coordination for members with non-intellectual and developmental disabilities enrolled in Home and Community Based Services (HCBS) waivers, including HCBS-EBD, HCBS-CMHS, HCBS-BI, and HCBS-CIH along with members enrolled in CFC. This position conducts in-person home visits, manages care plans, and coordinates services to support members in safely remaining in their homes and communities.  The non-IDD Case Manager collaborates with internal teams and external partners to ensure comprehensive, member-centered care and effective service delivery.

IDD:

The IDD Case Manager provides ongoing care coordination for members with intellectual and developmental disabilities enrolled in HCBS, SLS, and DD waivers as well as state funding programs and members enrolled in CFC. This position conducts in-person home visits, manages care plans, and coordinates services to support members in safely remaining in community-based living settings.  The IDD Case Manager collaborates with internal teams and external partners to ensure comprehensive, member-centered care and effective service delivery.

Children’s:

The Children’s IDD Case Manager provides ongoing care coordination for members ages birth through age 20 with both intellectual and developmental disabilities and delays as well as non- intellectual and developmental disabilities and delays who are enrolled in Home and Community Based Services (HCBS) waivers, including HCBS-CES, HCBS-CHRP and HCBS-CwCHN along with members enrolled in CFC.  This position conducts in-person home visits, manage care plans, and coordinate services to support members in safely remaining in community-based living settings.  The Children’s Case Manager collaborates with internal teams and external partners to ensure comprehensive, member-centered care and effective service delivery.  

The Family Support Services Program (FSSP) Case Manager provides individualized supports and services for families who are caring for a child between the ages of 3-18 who have intellectual and developmental disabilities or delays who are enrolled in the FSSP program.

Essential Duties

Responds to correspondence from the member, family or provider within two business days. This can include questions, requests, concerns, status updates, etc.

Completes required in-person assessments at the members residence 

Completes required in-person deliverables such as (but not limited to) monitoring's with the member and care team when appropriate

Ensures all eligibility requirements and approved prior to authorizing services 

Schedule assigned assessments and service plans with the member and care team in the timeframe required.

Ensure certifications are submitted to the county to process long-term care applications.

Monitor case status of long-term care application for programs after assessment is completed.

Collaborate with physicians, healthcare professionals and program approved service agencies to obtain required documentation for case processing according to regulations.

Assist members and their care teams to find appropriate service providers and/or necessary resources.

Complete all necessary paperwork according to rules and regulations within.

Responds to the complex needs of members and represents RMHS in team meetings to determine services and supports needed to meet the member’s needs.

Monitors and responds to incident reports and critical incident reports.

Responsible for the management of an assigned caseload to include meeting all deadlines and requirements.

Participate in training and staff development activities as assigned, including team meetings.

Work independently in a remote environment as well as in office as required and requested depending on the business needs.

Maintains professional and ethical behaviors in all interactions with members, care teams, and RMHS internal staff while meeting expectations and quality standards set by RMHS.

Knowledge, Skills, and Abilities                                                                                                              

Communicates professionally and empathetically both verbally and in writing.

Knowledge, understanding and competency about members who have disabilities and members who are elderly.

Maintains confidentiality per HIPAA guidelines.

Ability to manage your own schedule and work hours to effectively complete tasks assigned.

Ability to manage multiple priorities and work in a fast-paced environment.

Ability to speak calmly and help de-escalate members who may be upset by showing care and compassion.

Ability to solve problems and concerns as they arise.

Ability to attend in-person meetings with members at their residence.

Knowledge of basic computer skills and ability to navigate client management systems.

Ability to represent RMHS’s mission, vision, and values.

Minimum Qualifications

A bachelor’s degree; or

Five (5) years of relevant experience in the field of LTSS, which includes Developmental Disabilities; or

Some combination of education and relevant experience appropriate to the requirements of the position.

Driving Category - Requirements

Driving Category B:

Employees who may drive RMHS or personal vehicles for business purposes. Category B employees may transport other employees but will not transport RMHS clients.

• Valid driver’s license
• Proof of motor vehicle insurance
• Personal vehicle in good operating condition for use during work, including transporting individuals
• No major violations in the past three years.
• No more than two moving violations in the past three years
• Ability to meet and maintain agency driving requirements and operate agency vehicles
• Drivers must upload proof of ongoing auto insurance every 6 months into Paycom/Relias.

Preferred Qualifications

Previous case management experience

Degree in social work, psychology, sociology or other human services

Spanish Speaking