Case Manager

Department: Care Preferred - Case Management
Reports To: Chief of Care Coordination

Position Overview:

This position serves as the Case Manager for Partners Health Plan’s Medicaid only Line of Business. The Care Preferred Case Manager supports “Care Preferred” members with their need to manage specific health conditions, by general coordination of medical long term supports and monitoring their access to appropriate health care providers.

Duties and Responsibilities:

  • Completes welcome calls to newly enrolled members; collecting current information and history to determine if member qualifies for, or requires, support from the plan with specific disease management or pertinent health conditions.
  • Assist members who are opting in to “case management” as needed. Provide members with support in maintaining access to appropriate health care providers and services.
  • Ensures member information is entered correctly in electronic health record system so welcome packets/ID cards can be sent.
  • Maintains electronic health record and digital file for member. Obtains and uploads pertinent documents.
  • Arranges for completion of either the CAS or UAS assessment tool for members, by an external resource. Obtains and reviews results.
  • For members with DD specific Waiver Services, serves as PHP liaison with respective CCO Care Manager. Works with CCO Care Manager to integrate service needs.
  • Serves as PHP liaison with Health Smart’s call center, doctors, and other providers.
  • Provide back-up to Utilization Management Coordinator as needed.
  • All other duties as assigned.

Qualifications:

  • Associate’s degree required, with a Bachelor’s degree preferred.
  • Minimum of two years’, (2), experience in the field of human services with experience in developmental disabilities preferred.
  • Prior experience in Case Management or Care Management, specifically in a managed care or insurance setting required.
  • Experience working with electronic health record systems required.
  • Excellent organizational, interpersonal, and verbal and written communication skills required.
  • Excellent computer skills with Microsoft Word and Excel along with time management, problem-solving and customer service skills also required.

Requirements of All Positions:

  • All employees shall meet PHP’s Compliance and Privacy Regulations, and attend at a minimum of one (1) hour of Compliance and Privacy educational training annually;
  • All employees shall master PHP’s Model of Care and complete all training requirements within the first thirty (30) days of employment and annually thereafter, or as required by state and federal regulations;
  • All employees are required to maintain confidentiality, protect privacy, comply with Protected Health Information regulations, and report violations;
  • Perform functions as they relate to “Improving Health Care Quality” as defined in the National Association of Insurance Commissioners Supplemental Health Care Exhibit that:
    1. Improve health outcomes;
    2. Prevent hospital readmission;
    3. Improve patient safety and reduce medical errors, and
    4. Provide wellness and health promotion activities.

Physical Demands and Work Environment:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel utilize objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl.

The employee must occasionally lift and/or move up to 25 pounds, and infrequently up to 50 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus. The noise level in the work environment is usually moderate.

Equal Opportunity Employer