Job Information
Independent Health Case Manager - Pediatric/Maternity in Buffalo, New York
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Overview
The Case Manager (CM) will be responsible for helping members achieve a level of well-being, to avoid preventative hospital admissions or readmissions through the administration of quality improvement functions. The CM will perform telephonic outreach to members, physicians, or other care givers to develop a plan of care for the member who needs CM services. The CM will perform case management functions using a member-centric, collaborative process to optimize the wellness and functional capability of members, using available resources to promote quality cost-effective outcomes. The Case Manager will apply the guiding principles for case management practice to include assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet a member’s comprehensive health needs. The CM will adhere to regulatory and compliance requirements, adhere to department productivity and quality metrics, and provide exceptional customer service to all internal and external customers.
Qualifications
Current, active, unrestricted, and registered nursing (RN) license, licensed master’s social worker (LMSW), master’s in social work (MSW), or licensed dietician with Case Management experience required.
Case Management Certification (CCM) required. Candidates without CCM certification are required to obtain it within 2 years of commencing employment.
Two (2) years of case management or clinical experience in acute medical/surgical/critical care and/or ambulatory setting required.
Proficient computer and Windows skills required, including MS Office.
Previous clinical experience in a managed care setting as a case/care manager preferred.
Clinical knowledge of the health and social needs of the population served.
Ability to identify barriers to a successful case management path.
Ability to interact effectively and professionally with internal and external customers.
Excellent critical thinking and time management skills.
Excellent written, verbal, and interpersonal communication skills with demonstrated and proven ability to provide exceptional customer service to external and internal customers; excellent customer service skills to include telephonic interviewing of members; motivational interviewing skills a plus.
Transferable knowledge, skill, and ability to complete job duties independently and proficiently.
Flexibility in work schedules and assignments required.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Assess the patient’s broad spectrum of immediate and long-term needs through evaluation of the patient’s social and medical history. Develop a plan of care based upon providers of care clinical assessments and patients, to identified population along the continuum of care staying within the scope of case management practice.
Provide ongoing assessment and documentation to monitor member’s response to the plan of care; revises as needed based on changes in the member’s condition, lack of response to the care plan, preference changes, transitions across settings, and barriers to care and services. Measures and reports outcomes that demonstrate the efficacy, quality, and cost-effectiveness of case management interventions to achieve goals.
Conduct comprehensive assessments of the member’s health and psychosocial needs; includes health literacy, cultural, clinical and laboratory data, claims history, contract and benefit language, related state and federal regulations, established clinical guidelines, and recent literature or research as appropriate to ensure valid case management decisions.
Facilitate communication and coordination between members of the healthcare team; facilitate safe transition of care along the healthcare continuum.
Ability to identify cases that would benefit from alternative care through assessment and evaluation of the patient’s needs, as well as available resources.
Apply appropriate medical policies to evaluate the medical necessity, appropriateness and efficient use of healthcare services, procedures, and facilities across the continuum of care.
Identify and review high-risk cases to ensure members are transitioned to the appropriate care.
Document the patient’s plan of care in a timely manner.
Employ evidence-based guidelines and other self-management resources to maximize the member’s health, wellness, safety, adaptation, and self-care.
Understand case management concepts such as roles, philosophies, principles, liability, and confidentiality issues. Apply these concepts in developing appropriate plan of care and goals based on the needs of the patient.
Improve outcomes by utilizing adherence guidelines, standardized tools, and proven processes to measure a member’s understanding and acceptance of the care plan, his/her willingness to change, and his/her support to maintain health behavior change.
Ensure compliance with regulatory standards as indicated; adhere to applicable local, state, and federal laws, as well as employer policies, governing all aspects of case management practice, including member privacy and confidentiality rights.
Actively participates in project teams and medical management initiatives as needed.
Assist in the orientation of associates as needed.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $33.50 - $38.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here (http://www.independenthealth.com/about/careers/additional-eeo-aap-information) for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.
Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community.
We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog.
We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more. Please click here (http://www.independenthealth.com/about/community-report) to view our Community Reports.
Apply today and join us on the journey to a happier, healthier, and more inclusive community.
We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. We are a drug-free workplace. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: accommodations@independenthealth.com or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.
Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.