Job Description:SelectHealth is a not-for-profit community health plan
serving more than 1 million members in Utah, Idaho, and Nevada. As part
of an integrated system with Intermountain Healthcare, we share a mission of
"Helping people live the healthiest lives possible" to ensure our members
and the communities we serve have the highest quality healthcare at the lowest
possible cost. SelectHealth's line of businesses (LOB) include
Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans and
fully-funded and self-funded Commercial plan.
Summary:
The field care manager partners with members, their family and/or
caregivers and providers so that they can self-manage their care, optimize
their functional health status, have quality outcomes and use the health
system appropriately. They are responsible for developing, documenting and
implementing a program designed to address the medical, physical,
mental, emotional, spiritual, social and supportive needs of the member.
The field care manager facilitates ongoing program activities as well as
provides care management services to program enrollees.
The field care manager can expect a majority of their time in the field
visiting our members in their homes, in long-term care facilities, or in
the community.
Must live in one of these Colorado Counties: Boulder, Broomfield,
Adams, Arapahoe, Douglas, Larimer, Weld, El Paso, Jefferson, Denver.
Scope:
This position requires both remote work and local travel to meet members in
their home's or community. Occasional in-office presence is required for
meetings and training. Position reports to a Healthy Connections Program
Manager or Director over a specific line of business. Conducts in-home,
community-based and telephonic/video assessments and updates to care plan.
Job Essentials:
Identifies members who are unable to adhere to a medical plan without
additional assistance and enrolls members who are willing to engage in care
management services by reviewing referrals, records and conducting
appropriate assessments.
Follows the applicable established model of care or care management program
policies and procedures to assess, establish and maintain a plan of care
which incorporates the member's individualized needs and goals within the
benefit plan throughout the care management process. Ensures the plan is
evidence based and consistent with goals and objectives of referral, payer
contract, or established care processes.
Maintains records by reviewing case notes; logging events and progress
according to applicable regulatory requirements such as NCQA, CMS and State
EQRO standards.
Coordinates and facilitates communication among
themember/family/representative,members of the healthcare team, and
other relevant parties (e.g. other payers, Sales Team, Employer
Groups, etc.) through interdisciplinary team meetings or other coordinated
comm
Contacts patient at prescribed intervals and as necessary to determine if the
goals are being achieved or if they continue to be appropriate and/or
realistic. Determines variances and refers patient to more comprehensive level
of care if indicated.
Minimum Qualifications
Bachelor's degree in Nursing (BSN) or Master's degree or higher in SW
(LCSW or PhD) from an accredited institution (degree will be verified)
Current RN or LCSW/PhD license in the State where care management services
will be provided.
Five years of clinical practice that may include quality assurance, home
care, community health or occupational health experience
Reliable transportation and the ability to travel within assigned geographical
region to meet members.
Strong written, and verbal communication and conflict resolution skills
Intermediate computer software skills in word processing and spreadsheet
programs
Ability to work independently, be self-motivated, have a positive
attitude, and be flexible in a rapidly changing environment
Preferred Qualifications
Cert fication in Case Management (CCM)
Familiar with Motivational Interviewing
Knowledge of government programs (i.e., Medicare; Medicaid).
Health insurance product knowledge.
Experience working with third-party payers
Ability to work independently and be flexible in a rapidly changing
environment.
3+ years of relevant case management experience serving persons determined
to have a Serious Mental Illness condition, individuals who are elderly
and/or persons with physical or developmental disabilities
Physical Requirements:
Ongoing need for employee to see and read information, assess member
needs, and view computer monitors.
- and -
Frequent interactions with providers, members that require employee to
verbally communicate as well as hear and understand spoken information,
needs, and issues accurately
- and -
Manual dexterity of hands and fingers, this includes frequent computer use
and typing for documenting member care, accessing needed information, etc.
Anticipated job posting close date:09/30/2024
Location:SelectHealth - Fort Collins
Work City:Fort Collins