Under the direction of the Senior Care Manager, the Care Manager (CM) is responsible for providing comprehensive care coordination services to members who are enrolled in the Health Services for Children with Special Needs (HSCSN) health plan. The CM routinely communicates with members on their assigned caseload to assess their needs; develop, monitor and evaluate treatment plan progress; and assist with coordinating care and referring to appropriate services for members who have moderate to complex medical and psychosocial needs.
Essential job duties:
Manages a caseload as outlined by CASSIP and Care Management Leadership.
Maintains compliance in accordance with contractual and care management requirements
Contacts enrollee at predetermined intervals based on stratification level or more frequently, as needed.
Conducts face-to-face visits at a frequency determined by the enrollee’s assigned stratification level or more if needed, with each enrollee/caregiver in their homes, physician’s offices, or other mutually agreed upon locations.
Assesses enrollees on enrollment and at intervals determined by the enrollee’s stratification level to identify needs/barriers and close gaps in care.
Identifies over/under utilization promptly, and takes appropriate action according to organizational policy.
Upon gathering health and mental/behavioral health, environmental, psychosocial and educational information, the CM develops, implements, and updates an accurate individualized comprehensive care coordination plan for each assigned enrollee in collaboration with the PCP and/or other multi-disciplinary team members including public agencies.
Completes routine care coordination and care management activities with attention to quality, timeliness and in compliance with company policy and national standards.
Consults with Senior Care Manager to review and prioritize cases, set objectives, identify, and report potential risk and utilization concerns.
Seeks advice from Senior Care Manager or other designated person with expertise in specialty areas when necessary.
Accurately and timely documents enrollee findings and interactions according to organizational policy.
Receives supervision by licensed staff according to oversight guidelines.
Understands and abides by HSCSN’s Confidentiality policy and procedure regarding enrollee specific information.
Participates in disposition and discharge planning activities. Contributes to the discharge plan in a timely manner, taking into consideration enrollee/family/significant others and match to healthcare resources.
Clearly communicates verbally and in writing.
Assists/empowers caregivers or enrollees to participate in care of child /self.
Assists assigned enrollees and their caregivers in understanding the importance of EPSDT and compliance with all health services. Strives to achieve target rate of compliance for preventive medical and dental services.
Assists with scheduling and monitors the compliance of mental health/medical appointments. Follows department policies for identifying and reporting noncompliance, missed appointments, and other reportable incidents including communication to primary care provider or specialist.
Applies advanced knowledge of conditions of target population/standard approaches to care management and care coordination to assigned enrollees.
Attend multidisciplinary meetings as necessary, including off-site meetings with other involved agencies.
Receives and reviews reports of visits by vendors or contracted providers to enrollees receiving services and facilitates coordination of follow-up care, as needed.
Refers enrollee/caregiver to appropriate vendor(s) on DME/assistive technology use. Educates on medication administration, about their conditions, and techniques for self-management within the scope of license. Refer, as needed, to appropriate vendor for additional education.
Assist enrollees in planning for transitions of care to include but not limited to transitioning from Early Intervention to DCPS; from pediatric to adult providers; transitioning out of HSCSN when the enrollee ages out or is disenrolled for any reason; from outpatient to inpatient or the reverse; and entering or exiting the custody of CFSA, DYRS or any type of institutional care.
Enters authorizations for services requiring authorization by Care Management staff.
Keeps abreast of changing strategies and trends in care coordination and care management.
Uses communication skills which promote understanding and collaboration with enrollees and their families, HSCSN staff, providers and others.
Positively presents accurate information about HSCSN to enrollees and their families, HSCSN staff, providers, coworkers and the community.
Maintains professional, courteous and customer focused demeanor in all interactions.
Demonstrates knowledge of medical terminology and health care delivery systems.
Applies time management and organizational skills effectively.
Licensed in DC as a Social Worker (LICSW, LGSW, or LSWA), Registered Nurse (RN), Licensed Practical Nurse (LPN), or Licensed Professional Counselor (LPC). Certification as a Case Manager preferred.
Associates degree required. Bachelor’s degree preferred.
Master’s degree is required for certain special populations as outlined by CASSIP.
DC Residents are encouraged to apply!