South Carolina

Field Care Manager

Job description          

Department: South Carolina Care Management Reports to: Manager, Care Management Location: Columbia, SC
Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member. Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Coordinates the care and services of selected member populations across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. while collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.

Essential Functions: Evaluates members for case management services and determines appropriate level of care coordination/ management services for member. Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services. Acts as a primary case manager for members identified as Complex as defined by Case Management Program Description. Develops and monitors members plan of care, to include progress toward meeting established goals and self-management activities. Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan. Supervises and/or acts as a resource for non-clinical staff (i.e., Service Coordinators and Field Social Workers). Act as liaison and member advocate between the member/family, physician and facilities/agencies. Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines. Coordinates community resources, with emphasis on medical, behavioral, and social services. Applies case management standards, maintains HIPAA standards and confidentiality of protected health information and reports critical incidents and information regarding quality of care issues. Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities. Meets with clients in their homes, work-sites, physician’s or hospital to provide management of services. Adapts to changes in policies, procedures, new techniques and additional responsibilities. Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds. Perform other duties as assigned. Additional Responsibilities: Travel to inpatient bedside, member’s home, provider’s office, hospitals, etc required with dependable car. May spend up to 70% of time traveling with exposure to inclement weather and normal road hazards. May require climbing multiple flights of stairs to a member's home, provider's office, etc. Candidate Education: Required A Bachelor's Degree in Health Services or Nursing Required or equivalent work experience Candidate Experience: Required 2 years of experience in clinical acute care, post acute care, home health care, or maternity Preferred 1 year of experience in current case management Preferred Other Managed care experience Preferred Other Prior utilization management experience preferred in some geographic regions Preferred Other Experience in care of the elderly is required in some geographic regions Preferred Other Experience in home health, physicians office or public health Required Other Associates supporting Florida's Children’s Medical Services (CMS) must have a minimum of two (2) years’ experience in Pediatrics. Required Other Work experience requirements may be waived for associates engaged in Florida's CMS contract that worked in a similar capacity for Florida's Department of Health in 2018. Candidate Skills: Intermediate Ability to multi-task Intermediate Ability to work independently Intermediate Demonstrated time management and priority setting skills Intermediate Demonstrated interpersonal/verbal communication skills Intermediate Ability to create, review and interpret treatment plans Intermediate Ability to implement process improvements Intermediate Ability to effectively present information and respond to questions from families, members, and providers Intermediate Other Ability to understands the business and financial aspect of case mgmt in a managed care setting Intermediate Knowledge of healthcare delivery Intermediate Knowledge of community, state and federal laws and resources Intermediate Demonstrated written communication skills Intermediate Demonstrated customer service skills Licenses and Certifications:
A license in one of the following is required:
Required Licensed Registered Nurse (RN) Required Other Maintain required contact hours to fulfill regulatory requirements Preferred Certified Case Manager (CCM) Technical Skills: Required Intermediate Microsoft Word Required Intermediate Microsoft Excel Required Intermediate Microsoft Outlook Required Intermediate Healthcare Management Systems (Generic) Languages: Required Other In the state of NY, associates may be required to be proficient in one of two buckets of languages. Bucket one consists of the below: Required Bengali Required Other Bucket two consists of: Required Other Cantonese Required Other Fujianese
WellCare South Carolina jobs

WellCare

South Carolina jobs

South Carolina jobs

 South Carolina jobs  South Carolina jobs

Responsible for obtaining, verifying, and collecting insurance information from patients and client reports. Responsible for uploading to client system and following up with insurance companies for...

Production Operator - Cowpens, SC - copy

139 Price Farm Rd
Cowpens, South Carolina, 29330
United States

WestRock (NYSE: WRK) partners with our customers to provide differe...

Innovate to solve the world's most important challenges Produce high quality products and services for our customers. You will assemble and inspect product to ensure the highest quality product is ...

More Information about this Job Job Title: Supervisor Operations FLSA Status: Exempt
POSITION SUMMARY: Work with the Manager of Operations to ensure that all Field Supervisors, Support Service...

Financial Analyst
2019-09-17

The mission of the Financial Analyst is to assist the Business Controller and Assistant Business Controller in financial administration, ensuring accurate and precise financial reporting, review re...

WellCare South Carolina jobs

WellCare (South Carolina jobs)

 Jobs in organization(state)

Job Summary:
To provide unpaid volunteer services to the hospice patients and their families.

Qualifications:
Excellent communication skills, both verbal and written Ability to ac...

Field Care Manager
2019-09-11

Department: South Carolina Care Management Reports to: Manager, Care Management Location: Columbia, SC
Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, mon...

Conducts telephonic outreach to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements. Provides education to members re...