For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
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Responsibilities:
The Clinical Case Manager assists members who are eligible for LTSS in obtaining the services they need as required by DSHP Plus LTSS in New Castle county. He or she contributes to the LTSS case management process by performing telephonic and/or face-to-face assessments for the identification, evaluation, coordination and management of member’s needs, including physical health, behavioral health, social services and long term services and supports. This position is also responsible for completing Level of Care Redeterminations for home and community based members annually. This requires clinical review when evaluating the need for a member to remain in the program. The Clinical Case Manager will also provide clinical support to his/her non-licensed counterparts and may act as a secondary case manager when a member is experiencing an acute episode.
Coordination of care for medically complex LTSS Members receiving private duty nursing (PDN)
Performs follow-up on outstanding items of need and maintains a calendar or PDN Coverage.
Establish communication method to effectively communicate with multiplePDN agencies and member/member representative.
Coordinates and collaborates with prior authorization team to make sure all necessary precertifications for required services are submitted for review. Assists in obtaining the Letter of Medical Necessity (LOMN) as needed
Coordinate with provider network team in the utilization of non-contracted providers or facilities as necessary following the single case agreement (SCA) process
Conducts reevaluation of level of care annually or more frequently as needed in accordance with DSHP Plan Plus LTSS requirements.
Provides clinical support to non-licensed case managers as needed.
Conduct condition specific assessments with members with chronic conditions. Provide education and routine follow-up with member.
Perform initial clinical assessment of new members, develop care plan, and initiate services.
Facilitate person-centered planning team meetings to coordinate care and services. Identify, coordinate, and assist participants in gaining access to needed LTSS and other Covered Services, as well as non-covered medical, social, housing, educational, and other services and supports.
Provides information to participants and conducts monitoring of authorized services and supports for Participants.
Informs participants about available LTSS required needs assessments, the care plan process, service alternatives and service delivery options.
Informs participants of their rights and responsibilities…