Case Manager - Pediatric/Maternity

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

The Case Manager (CM) will be responsible for helping members achieve a level of well-being, to avoid preventative hospital admissions or readmissions through the administration of quality improvement functions. The CM will perform telephonic outreach to members, physicians, or other care givers to develop a plan of care for the member who needs CM services. The CM will perform case management functions using a member-centric, collaborative process to optimize the wellness and functional capability of members, using available resources to promote quality cost-effective outcomes. The Case Manager will apply the guiding principles for case management practice to include assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet a member's comprehensive health needs. The CM will adhere to regulatory and compliance requirements, adhere to department productivity and quality metrics, and provide exceptional customer service to all internal and external customers.

• Current, active, unrestricted, and registered nursing (RN) license, licensed master's social worker (LMSW), master's in social work (MSW), or licensed dietician with Case Management experience required.
• Case Management Certification (CCM) required. Candidates without CCM certification are required to obtain it within 2 years of commencing employment.
• Two (2) years of case management or clinical experience in acute medical/surgical/critical care and/or ambulatory setting required.
• Proficient computer and Windows skills required, including MS Office.
• Previous clinical experience in a managed care setting as a case/care manager preferred.
• Clinical knowledge of the health and social needs of the population served.
• Ability to identify barriers to a successful case management path.
• Ability to interact effectively and professionally with internal and external customers.
• Excellent critical thinking and time management skills.
• Excellent written, verbal, and interpersonal communication skills with demonstrated and proven ability to provide exceptional customer service to external and internal customers; excellent customer service skills to include telephonic interviewing of members; motivational interviewing skills a plus.
• Transferable knowledge, skill, and ability to complete job duties independently and proficiently.
• Flexibility in work schedules and assignments required.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

• Assess the patient's broad spectrum of immediate and long-term needs through evaluation of the patient's social and medical history. Develop a plan of care based upon providers of care clinical assessments and patients, to identified population along the continuum of care staying within the scope of case management practice.
• Provide ongoing assessment and documentation to monitor member's response to the plan of care; revises as needed based on changes in the member's condition, lack of response to the care plan, preference changes, transitions across settings, and barriers to care and services. Measures and reports outcomes that demonstrate the efficacy, quality, and cost-effectiveness of case management interventions to achieve goals.
• Conduct comprehensive assessments of the member's health and psychosocial needs; includes health literacy, cultural, clinical and laboratory data, claims history, contract and benefit language, related state and federal regulations, established clinical guidelines, and recent literature or research as appropriate to ensure valid case management decisions.
• Facilitate communication and coordination between members of the healthcare team; facilitate safe transition of care along the healthcare continuum.
• Ability to identify cases that would benefit from alternative care through assessment and evaluation of the patient's needs, as well as available resources.
• Apply appropriate medical policies to evaluate the medical necessity, appropriateness and efficient use of healthcare services, procedures, and facilities across the continuum of care.
• Identify and review high-risk cases to ensure members are transitioned to the appropriate care.
• Document the patient's plan of care in a timely manner.
• Employ evidence-based guidelines and other self-management resources to maximize the member's health, wellness, safety, adaptation, and self-care.
• Understand case management concepts such as roles, philosophies, principles, liability, and confidentiality issues. Apply these concepts in developing appropriate plan of care and goals based on the needs of the patient.
• Improve outcomes by utilizing adherence guidelines, standardized tools, and proven processes to measure a member's understanding and acceptance of the care plan, his/her willingness to change, and his/her support to maintain health behavior change.
• Ensure compliance with regulatory standards as indicated; adhere to applicable local, state, and federal laws, as well as employer policies, governing all aspects of case management practice, including member privacy and confidentiality rights.
• Actively participates in project teams and medical management initiatives as needed.
• Assist in the orientation of associates as needed.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $33.50 - $38 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub app.