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Care Manager - LPN

HSC Health Care System Washington, DC

  • Posted: over a month ago
  • Full-Time
  • Benefits: medical, vision, 401k, dental
Job Description

Job Requirements

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. 

 

JOB FUNCTIONS

Essential job duties:

  1. Manages a caseload as outlined by CASSIP and Care Management Leadership. 
  2. Maintains compliance in accordance with contractual and care management requirements 
  3. Contacts enrollee at predetermined intervals based on stratification level or more frequently, as needed. 
  4. 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.  
  5. Assesses enrollees on enrollment and at intervals determined by the enrollee’s stratification level to identify needs/barriers and close gaps in care.
  6. Identifies over/under utilization promptly, and takes appropriate action according to organizational policy.
  7. 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.  
  8. Completes routine care coordination and care management activities with attention to quality, timeliness and in compliance with company policy and national standards.
  9. Consults with Senior Care Manager to review and prioritize cases, set objectives, identify, and report potential risk and utilization concerns. 
  10. Seeks advice from Senior Care Manager or other designated person with expertise in specialty areas when necessary.
  11. Accurately and timely documents enrollee findings and interactions according to organizational policy.
  12. Receives supervision by licensed staff according to oversight guidelines.
  13. Understands and abides by HSCSN’s Confidentiality policy and procedure regarding enrollee specific information.
  14. 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.
  15. Clearly communicates verbally and in writing.
  16. Assists/empowers caregivers or enrollees to participate in care of child /self.
  17. 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.
  18. 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.
  19. Applies advanced knowledge of conditions of target population/standard approaches to care management and care coordination to assigned enrollees.
  20. Attend multidisciplinary meetings as necessary, including off-site meetings with other involved agencies.  
  21. Receives and reviews reports of visits by vendors or contracted providers to enrollees receiving services and facilitates coordination of follow-up care, as needed.  
  22. 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. 
  23. 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.
  24. Enters authorizations for services requiring authorization by Care Management staff.
  25. Keeps abreast of changing strategies and trends in care coordination and care management.
  26. Uses communication skills which promote understanding and collaboration with enrollees and their families, HSCSN staff, providers and others.
  27. Positively presents accurate information about HSCSN to enrollees and their families, HSCSN staff, providers, coworkers and the community.
  28. Maintains professional, courteous and customer focused demeanor in all interactions.
  29. Demonstrates knowledge of medical terminology and health care delivery systems.
  30. Applies time management and organizational skills effectively.

 

Care Manager (Special Populations):

  1. The responsibilities of the Care Management staff assigned to these populations are inclusive of the duties outlined above with further detail in their respective program description and/or policy.

 

Other job duties:

  1. May perform other duties in addition to those outlined in this job description

 

 

QUALIFICATIONS:

Required Experience:

  1. Three to five years of related experience in managed care and /or care management
  2. Three to five years’ experience in clinical or community resource settings  
  3. Effective verbal and written communication skills
  4. Bilingual (Spanish speaking) preferred 
  5. Familiar with medical terminology
  6. Familiarity with computer systems and applications, particularly in Microsoft Office suite
  7. Strong organizational skills 
  8. Ability to interpret and apply departmental requirements  
  9. Ability to make sound decisions and use good judgment
  10. Ability  to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
  11. Ability to participate in professional, multidisciplinary meetings to include internal and external staff meetings

License/Certifications:

Licensed Practical Nurse (LPN).  Certification as a Case Manager preferred.

 

Required Education:

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!

Company Description
The HSC Health Care System provides and coordinates innovative, high quality, community-based care for individuals with complex needs and their families. HSC empowers all we serve to improve the quality of their lives.

The HSC Health Care System (HSC) is a nonprofit health care organization committed to serving families and adults with special health care needs and eliminating barriers to health care services. The System combines the resources of a health plan (Health Services for Children with Special Needs, Inc.), pediatric specialty hospital (The HSC Pediatric Center), home health agencies (HSC Home Care, LLC and HSC Health and Rehabilitative Services), and parent foundation (The HSC Foundation) to offer a comprehensive approach to caring, serving and empowering people with disabilities.

HSC employs over 700 staff members, with operating revenue of approximately $225 million annually. Strategic plans include further expansion of services into broader territories, including Virginia. As a first-of-its-kind health system in Washington, DC with more than a century of experience, The HSC Health Care System remains committed to changing the lives of the people we serve through expert medical care, care coordination and advocacy. Today, we are known for our expertise in treating children, teens and adults who have disabilities and complex medical conditions.

HSC Health Care System

The HSC Health Care System provides and coordinates innovative, high quality, community-based care for individuals with complex needs and their families. HSC empowers all we serve to improve the quality of their lives. The HSC Health Care System (HSC) is a nonprofit health care organization committed to serving families and adults with special health care needs and eliminating barriers to health care services. The System combines the resources of a health plan (Health Services for Children with Special Needs, Inc.), pediatric specialty hospital (The HSC Pediatric Center), home health agencies (HSC Home Care, LLC and HSC Health and Rehabilitative Services), and parent foundation (The HSC Foundation) to offer a comprehensive approach to caring, serving and empowering people with disabilities. HSC employs over 700 staff members, with operating revenue of approximately $225 million annually. Strategic plans include further expansion of services into broader territories, including Virginia. As a first-of-its-kind health system in Washington, DC with more than a century of experience, The HSC Health Care System remains committed to changing the lives of the people we serve through expert medical care, care coordination and advocacy. Today, we are known for our expertise in treating children, teens and adults who have disabilities and complex medical conditions.

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