Insurance Case Manager Jobs in Mableton, GA (NOW HIRING)

Description

Positive Impact Health Centers (PIHC) is a community leader in providing HIV prevention, care and treatment services. The PIHC model of care assures that persons with HIV have access to medical, pharmacy, dental, behavioral health and social services, providing the best opportunity for patients to achieve high-quality health outcomes.

JOB SUMMARY: The Medical Case Manager (MCM) will provide medical case management services to eligible adult clinic patients at Positive Impact Health Centers, following applicable funding guidelines and best practice care models. The MCM will function as an integral member of an interdisciplinary team which may include the following: medical provider, behavioral health clinician, medication access specialist, clinical pharmacist, and supportive services staff (Community Health Worker, Patient Navigator, Retention/Adherence Manager).

This position description should not be interpreted as all-inclusive. It is intended to identify the major responsibilities and requirements of this position. The incumbent may be requested to perform job-related responsibilities and tasks other than those stated in this position description.

ESSENTIAL FUNCTIONS:

Duties and Responsibilities:

Learn and remain current on practice issues related to HIV/AIDS, related medical diagnoses, and medical case management.

Provide medical case management services to identified patients of the clinic program, following medical case management guidelines established by HRSA/Ryan White and the Metropolitan Atlanta HIV Health Services Planning Council.

Provide instruction and supervision to assigned staff regarding Federal, State, health district, and agency standards, procedures and policies.

Ensure that assigned staff are performing day-to-day operations, including but not limited to the coverage of the departmental Resource Line and the scheduling of patient enrollment visits.

Provide medical case management services to an average caseload size of 40 patients: develop a comprehensive Individualized Service Plan (ISP); 

Assign clinic patients to Medical Case Managers (MCM) for medical and non-medical services, utilizing Acuity Level scores and service needs while also maintaining equitable caseload sizes for MCM staff.

Participate in weekly interdisciplinary Case Conference meetings, leading the meeting as needed.

Participate in daily huddles with assigned care team, and assist with documentation of summary.

Collaborate with Site Coordinator and Data Team to collect data and review reports for assigned care team to measure patient acuity and health care outcomes, and staff productivity. 

Assist with the orientation of new medical case managers at the designated PIHC Center.

Assist and consult with interdisciplinary care team regarding patients' ongoing need for care and referrals.

Assist Site Coordinator with managing the EMR Medical Case Management pool and assign clients to medical case manager accordingly.

Document patient information, activities, referrals and consultations in a timely and accurate manner, through the use of the agency's electronic medical record system and related reporting software. 

Abide by all state, federal laws and agency policies as related to confidentiality and Health Insurance Portability and Accountability Act (HIPAA).

Organize and lead weekly team meetings.

Monitor time and attendance of assigned staff in agency's electronic payroll system. 

Complete performance evaluations with assigned staff.

Abides by all agency policies and procedures, including conflict of interest policy. 

Requirements

Knowledge, Skills, and Abilities:

• Must possess exemplary interpersonal skills and a willingness to work effectively with diverse patients and staff.
• Must possess skillful written and verbal communication skills and the ability to work effectively in a multi-cultural setting.
• Must possess and be willing to apply innovative and effective problem-solving skills as needed.
• Willingness to work independently but know when to seek supervision.
• Must possess good time management skills and a demonstrated ability to see tasks through to completion

Minimum Qualifications:

Master's degree in social work, human services or public health

Basic computer skills

Experience:

Minimum one-year experience in social work or related service delivery field.

One year of professional experience in an HIV service setting preferred.

Administrative or supervisory experience preferred.

Experience documenting in an Electronic Medical Record (EMR) system required

License/Licensure:

•  Licensure, if applicable to degree held (e.g. LMSW or LCSW when holding an MSW degree), is encouraged

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit and talk or hear. The employee is occasionally required to walk, use hands to finger, handle, or operate computers, objects, tools, or controls and reach with hands and arms.

The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

NOTES:

1. Positive Impact Health Centers, Inc., is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, or covered veteran status.
2. Recreational drugs, weapons and violence are not permitted on agency property or at any agency events or programs.
3. The above job description represents the general nature, primary duties and responsibilities, and qualifications for the work performed by employees within this job, but is not a comprehensive and exhaustive list. Employees may be required to perform other duties as assigned, and specific duties, responsibilities, and activities within the core nature of the job may change at any time with or without notice. Employees must be able to perform the essential functions of the job, as specified by the employing entity, with or without reasonable accommodation.
4. Where permitted by applicable law, must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered for all jobs, if not currently employed by Positive Impact Health Centers.