3400 Martin Luther King Jr. Ave SE
Washington, DC 20032
Kids Are Our Everything.
Department
10514 HSCSN - Care Management
Pay Range
$65,124.80 - $108,555.20
Under the direction of the Supervisory Care Manager, the Care Manager I (CMI) 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 CMI 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.
Minimum Education
Master's Degree (Required)
Minimum Work Experience
2 years Two or more years of healthcare or related experience in managed care and /or care management (Preferred)
2 years Two or more years experience in clinical or community resource settings (Preferred)
Required Skills/Knowledge
Effective verbal and written communication skills
Bilingual (Spanish speaking) preferred
Familiar with medical terminology
Proficiency with computer systems and applications, particularly in Microsoft Office suite
Strong organizational skills
Ability to interpret and apply departmental requirements
Ability to make sound decisions and use good judgment
Ability to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
Ability to participate in professional, multidisciplinary meetings to include internal and external staff meetings
Required Licenses and Certifications
Graduate Social Worker Licensed in DC as a Licensed Graduate Social Worker (LGSW) (Required) Certified Case Manager (Preferred)
Job Functions
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 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…