Case Manager ; MSW​/RN - Medicare​/DSNP

Remote Washington State
Seattle, WA 98101, USA

• Travel Required :
  Yes

This position is remote. We are targeting an individual who lives in the Seattle area and is knowledgeable of the area and its available resources. This is essential in being able to assist our Medicare and Dual Plan members by providing education coordination with care teams and connecting to community-based resources.

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to a pply an equity lens to all our work.
• Become an anti-racist organization
• Create an equitable work environment.

About the Role

Responsible for the operational delivery of the plan’s case management and coordination programs and processes. Provides case management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness, and/or highly complex medical/behavioral and social conditions. The goal is to improve members' quality of life and ensure cost-effective outcomes by using internal and community-based resources.

To be successful in this role, you:

• Have a Bachelor’s degree in nursing, or a master’s degree in social work and/or related behavior health field (preferred)
• Possess Current, unrestricted license in the State of Washington as a registered nurse (RN) (required) OR
• Current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required), OR
• Current, unrestricted license in the State of Washington as a Mental Health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required)
• Have a minimum of one (1) year case management, home health or discharge planning experience; or a combination of education and experience which provides an equivalent background required OR
• Have a minimum of one (1) year facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse/substance abuse disorder treatment experience, required; or equivalent combination of education and experience and/or working with children and families. Experience with those who have disabilities and knowledge of Child and Families Services
• Have a minimum three (3) years of clinical experience in an acute care and/or outpatient setting (required)
• Experience and proficiency with Microsoft Office products
• Possess a Case Management Certification (preferred)
• Have Bilingual abilities (preferred)

Essential functions and

Roles and Responsibilities:

The Case Manager I is responsible for performing telephonic case management for members with acute, chronic, and complex needs. Examples listed below are not necessarily exhaustive and may be revised by the employer.

• Advocates on behalf of members and facilitates coordination of resources required to help members reach optimum functional levels and autonomy within the constraints of their disease conditions.
• Works within a multi-functional team to connect with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs and ensure access to appropriate services to achieve positive health outcomes.
• Assesses, evaluates, plans, implements, and documents care of members within the organization’s clinical database system, in accordance with organizational policies and procedures.
• Responsible for the assessment of members, including identifying and coordinating access to the appropriate level of care and treatment. Uses the assessment information to assign the appropriate risk and complexity level, and create and document a care plan in coordination with the member, family and health team input.
• Initiates a plan of care based on member-specific needs, assessment data and the medical/behavioral plan of care. Goals for members are measurable and developed in conjunction with the patient/family to improve quality of life.
• Plans care in collaboration with members…