Medical Case Manager

Job not on LinkedIn

🔥 4 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $72.7k - $116.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

💰 $5M Grant on 2021-05

Healthcare Insurance • Non-profit • Social Impact

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Assures that members with complex medical and/or psychosocial needs have access to high quality, cost-effective health care. • Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes and activities necessary to facilitate member access to healthcare services. • Advocates for the most appropriate care plan using sound clinical judgment; accurate planning, and collaboration with internal and/or external customers and contacts. • Follows established regulatory guidelines, policies, and procedures in relation to member interventions and documentation of activities related to the member’s care and progress across the continuum of care. • Facilitates and/or participates in interdisciplinary and/or interagency meetings, when necessary, to facilitate coordination of services/resources for members. • Communicate effectively while performing customer telephonic interviewing and communication with external contacts. • Educate members to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes. • Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care. • Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs. • Work primarily independently to identify, define, and resolve a myriad of problem types experienced by the member. • Develop an individualized plan of care designed to meet the specific needs of each member. • Anticipate the needs of members by continually assessing and monitoring the member’s progress toward goals, care plan status, and re-adjust goals when indicated. • Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services. • Coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible.

🎯 Requirements

• Minimum Bachelor’s degree in nursing or RN certification in lieu of bachelor's degree or Master’s degree in Social Work, Counseling, Education, or related field and 3 years' experience in Acute or Managed Care/ experience with Medicaid or Medicare populations. • Bachelor’s degree in Social Work with five years’ experience in Acute or Managed Care/ experience with Medicaid or Medicare populations • Preferred Experience working with high-risk pregnant women or experience working with chronic condition adult populations or experience with pediatrics 3 years of experience in working in Acute Care/Managed Care/Medicaid and Medicare populations. • Bilingual English/Spanish language skills. • Case Management Certification • Required Licensed Social Worker (LSW)-Non-Specific - State (OR) Licensed Professional Counselor (LPC) - Non-Specific State (OR) Licensed Bachelors Social Worker (LBSW) (OR) Licensed Clinical Social Worker (LCSW) - Non-Specific (OR) Licensed Master Social Worker (LMSW) Non-Specific (OR) Licensed Graduate Social Worker (LGSW) (OR) Licensed Certified Social Worker (LCSW) (OR) Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).

🏖️ Benefits

• Health insurance • Professional development opportunities