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Healthcare - Care Manager II Care Manager II
Healthcare - Care Manager II Care Manager IIIntegrated Resources • Irving, TX, United States
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Healthcare - Care Manager II Care Manager II

Healthcare - Care Manager II Care Manager II

Integrated Resources • Irving, TX, United States
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Job Title : Case Manager II

Job Location : Dallas, TX (Remote)

Job Duration : 6 months (Possibility of Extension)

Shift : 8 : 00am - 5 : 00 pm

What is the expected schedule (include dates / time / time zone)- usually Monday - Friday 8am - 5pm however may need to alternate at times to be able to locate members 7am to 4pm or 9 am to 6pm or ie : Saturday 8am to 12noon these time zones are CST for now

Job Summary :

  • Responsible for health care management and coordination of client members in order to achieve optimal clinical, financial and quality of life outcomes.
  • Works with members to create and implement an integrated collaborative plan of care.
  • Coordinates and monitors Client members progress and services to ensure consistent cost effective care that complies with Client policy and all state and federal regulations and guidelines.

Essential Functions :

  • Provides case management services to members with chronic or complex conditions including :

    • Proactively identifies members that may qualify for potential case management services.

  • Conducts assessment of member needs by collecting in-depth information from Clients information system, the member, members family / caregiver, hospital staff, physicians and other providers.
  • Identifies, assesses and manages members per established criteria.
  • Develops and implements a case management plan in collaboration with the member, caregiver, physician and / or other appropriate healthcare professionals to address the member needs.
  • Performs ongoing monitoring of the plan of care to evaluate effectiveness.
  • Documents care plan progress in Clients information system.
  • Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
  • Measures the effectiveness of interventions to determine case management outcomes.
  • Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Client members.
  • Conducts face to face or home visits as required.
  • Maintains department productivity and quality measures.
  • Manages and completes assigned work plan objectives and projects in a timely manner.
  • Demonstrates dependability and reliability.
  • Maintains effective team member relations.
  • Adheres to all documentation guidelines activities.
  • Attends regular staff meetings.
  • Participates in Interdisciplinary Care Team (ICT) meetings.
  • Assists orientation and mentoring of new team members as appropriate.
  • Maintains professional relationships with provider community and internal and external customers.
  • Conducts self in a professional manner at all times.
  • Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
  • Participates in appropriate case management conferences to continue to enhance skills / abilities and promote professional growth.
  • Complies with required workplace safety standards.

    • Required Education :

  • Bachelors Degree in Social Work or Health Education (a combination of experience and education will be considered in lieu of degree).

    • Required Education / Certification(s) :

  • Prefer RN or a LVN or a MSW.

    • Required Experience :

  • 2-4 years of clinical experience with Case Management experience.

    • Required Licensure / Certification :

  • Must have valid drivers license with good driving record and be able to drive locally.

    • Knowledge / Skills / Abilities :

  • Demonstrated ability to communicate, problem solve, and work effectively with people.
  • Excellent organizational skill with the ability to manage multiple priorities.
  • Work independently and handle multiple projects simultaneously.
  • Strong analytical skills.
  • Knowledge of applicable state, and federal regulations.
  • Knowledge of ICD-9, CPT coding and HCPC.
  • Knowledge of SSI, Coordination of benefits, and Third Party Liability programs and integration.
  • Familiarity with NCQA standards, state / federal regulations and measurement techniques.
  • In depth knowledge of CCA and / or other Case Management tools.
  • Ability to take initiative and see tasks to completion.
  • Computer skills and experience with Microsoft Office Products.
  • Excellent verbal and written communication skills.
  • Ability to abide by Clients policies.
  • Able to maintain regular attendance based upon agreed schedule.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
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    Care Manager • Irving, TX, United States

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