Under the supervision of the Supervisor orManager of Care Management, the Care Manager II-PRN is responsible for completing the appropriate level of care management activities for Colorado Access members. Specifically, this position will provide complex care coordination and case management for high acuity members and requires complex clinical decision making. Care management activities will include but will not be limited to completing assessments, determining eligibility, monitoring provider services, coordinating services, developing care plans, delivering care management interventions, appropriate follow up activities and completing all documentation in the expected time frame. The Care Manager II will apply appropriate criteria, guidelines, and regulations specific to the level of care and services required to meet the member/family goals and the organizational/contractual requirements. Care management functions may be performed for members in a variety of settings including telephonic, in-person or in the community setting.
Pro Re Nada (PRN) - will primarily be used for covering day shifts (Mon-Fri) for Care Management needs.
Assesses and identifies member strengths, needs, concerns, and preferences through interviewing, observing, and administering structured instruments, to collect data about the member’s health, function, behavior, mental health, cognition, environment, finances, and support system.
Performs advanced clinical assessments and provides clinical knowledge of emotional disorders, chronic health, medication issues, substance use disorders, communicable diseases, and advanced directives.
Establishes goals and care plans with members and their natural supports if applicable.
Implements care plans through coordinating services and interventions by referring, educating, negotiating, and mediating with members and formal or informal providers.
Manages and monitors the ongoing provision of and need for care by monitoring the delivery and quality of services and interventions provided. Performs ongoing monitoring of member status and satisfaction with services and makes adjustments to care plans as needed.
Assists in identification of risk factors leading to increased utilization and works to reduce preventable hospitalizations, readmissions, and inappropriate utilization.
Communicates with members utilizing person centered thinking and language through all aspects of care management.
Establishes professional and effective collaboration, communication, and coordination among all responsible parties of an individual member’s interdisciplinary health care team.
Actively participates in clinical presentations and or/ interdisciplinary team meetings, disposition planning, department meetings, and organizational meetings and communicates progress and barriers with Supervisor/Manager.
Maintains knowledge and educates members regarding various state plan benefits, programs, options and services.
Responsible for accurate and timely completion of all forms, reports, and documentation of care management activities.
Maintains professional and ethical manner with all interactions and meets performance, quality, customer service, and coordination standards as assigned by the department management team.
Assists members and providers in understanding the complaint, grievance and appeal process.
Participates in training and staff development opportunities. Actively participates in team meetings and communicates progress and barriers with Coordinator Supervisor and/or Department Manager.
COMPENSATION and BENEFITS:
Compensation:$28.00- $35.00.00 per hour and is a non-exempt (hourly) position. Pay rate/salary to be commensurate with experience.
Benefits: Employees who are working as PRN status are not eligible for company benefits.
Education: Master’s degree in human behavioral sciences field required and/or clinical license.
Experience: Three years of clinical, care management and/or healthcare experience required. Experience working with Medicare and Medicaid populations, and related social/economic issues delivering care management services, conducting assessments, interviewing members, developing service plans, coordinating care and monitoring services for members preferred.
Knowledge, Skills, and Abilities: Knowledge of managed care, care management and utilization management is required. Ability to process high volume of work efficiently with a high level of customer service detail. Knowledge of and ability to relate to populations served by the programs for which we work, client interviewing and assessment skills, knowledge of policies and procedures regarding public assistance programs, ability to develop care plans and service agreements, knowledge of resources, and negotiation, intervention, and interpersonal communication skills. Demonstrates support for the company’s mission, vision and values. Position requires excellent written and verbal communication skills, strong organizational and time management skills, strong interpersonal skills and the ability to handle multiple priorities. Position requires flexibility to use complex processes and procedures to facilitate quality outcomes and/or resolutions while working with other team members with varied skills and educational background. Ability to work independently outside of office setting and conducting face to face assessment visits. Must have general computer skills and ability to work with Microsoft Office products. Requires the ability to use the complaint, grievance and appeals process and procedures to facilitate quality outcomes and/or resolutions for members. May be required to manage multiple priorities and projects with tight deadlines.
Licenses/Certifications: If licensed, a current unrestricted Colorado license as a healthcare professional; LPC, LCSW, LMFT or RN. A valid driver's license and proof of current auto insurance will be required for any position requiring driving.
Internal Number: 155
About Colorado Access
We’re a locally based nonprofit health plan that’s been changing the health care landscape in Colorado for more than two decades. We are the only organization in Colorado caring for members across a continuum of health services, from Health First Colorado (Colorado’s Medicaid Program) physical and behavioral health to Child Health Plan Plus and long-term services and supports. Our broad view allows us to stay focused on our members’ unique needs while we create integrated systems to serve them better.