Care Coordinator (Case Manager) – Health Alliance Plan job vacancy in Health Alliance Plan – Jobs in Michigan

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Job Details
Company Name : Health Alliance Plan
Company Location : Troy, MI 48083
Job Position : Care Coordinator (Case Manager) – Health Alliance Plan
Job Category : Jobs in Michigan

Job Description :
GENERAL SUMMARY:
This position is responsible for case management services provided to the membership of HAP Empowered Health Link within the framework of the Annual Case Management Plan.
PRINCIPAL DUTIES AND RESPONSIBILITIES:

Perform comprehensive clinical and diagnostic assessments for members meeting institutional level of care.
Clinical and diagnostic evaluation and review of chronic condition information related to complex medical needs, behavioral health needs, activities of daily living (ADL’s) and instrumental activities of daily living (IADL’s) for long term supports and waivers.
Long term services and supports clinical and diagnostic assessments and care planning for members with complex and chronic conditions including performing and arranging for waiver services and personal care assistance.
Refer members to community resources for the appropriate agencies and organizations to enhance and supplement services for the member. Examples: Community Mental Health, Area Agency on Aging, Local Health Departments, Meals on Wheels and Transportation.
Initiates and implements an individual plan of care with attainable goals in conjunction with the member, health care providers, and community agencies. Modifies the plan of care through monitoring and re-evaluation to accommodate changes in treatment or progress for all assigned members.
Care coordination contacts include telephonic and face-to-face interaction with members in their homes, inpatient and outpatient settings, and institutional settings.
Documents the plan of care in accordance with HAP Empowered Policies, NCQA guidelines and Medicare/Medicaid requirements within the Case Management Program.
Performs on-going evaluation of quality and cost effectiveness of Case Management Services.
Documents care in accordance with HAP Empowered Policies.
Maintains statistical data, reports and logs as required.
Works with the Concurrent Review Nurse on evaluations of hospitalized members in need of discharge planning, transitions of care, medication reconciliation, and case management.
Works with the Referral Coordinator to ensure the member receives the correct and cost effective DME.
Interacts with Vendors, Specialists and Primary Care Physicians to authorize and coordinate services for members.
Presents medically complex questionable cases to the Case manager and/or Medical Director for review.
Assures maintenance and sharing of records, reports and assures HIPPA compliance.
Assists the Manager of Government Programs with Case Management Program planning, development, implementation and evaluation.
Attends identified Plan Committee and Staff Meetings.
Other duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

Bachelor’s degree in Social Work or Registered Nurse with an Associate’s degree in Nursing.
Master’s degree in Social Work, preferred.
Minimum of two (2) years of case management experience in inpatient and outpatient medical care, long-term care, managed care, home health care, behavioral health settings.
At least two (2) years of experience in waiver or long-term support services settings, preferred.
Medicaid/Medicare and/or HMO experience (Managed Care experience), preferred.
Experience with electronic health and case management systems, preferred.
Participate in Performance Measurement Criteria by: cost reductions, admission statistics, accuracy of data, and accuracy of interpretation of concurrent reviews.
Self-starter who is analytical, organized, intuitive, and investigative.
Good written and interpersonal communication skills.
Strong problem-solving skills, extensive telephone involvement and Care Management coordination.
Manual dexterity to operate PC (MS Word, Excel).
Excellent customer service.
Knowledge of medical terminology and ICD-9 and CPT coding.
Follows State and Federal HMO regulations as related to Utilization Management.

CERTIFICATIONS REQUIRED:

Must have an active State of Michigan license in good standing and without prior or current restrictions as Licensed Bachelor’s Social Worker (LBSW), Licensed Master’s Social Worker (LMSW), Limited Licensed Master’s Social Worker (LLMSW), or Registered Nurse (RN).
Michigan Driver’s Licenses without restrictions.
Have regular access to a registered vehicle with no fault insurance coverage in your name.
Certified Case Manager, preferred.
Qualified Mental health Professional (QMHP) certification, preferred.