Medical Case Manager

Description:
Case Management is a collaborative process which includes assessment, planning, implementation, coordination, monitoring, and evaluation of options and services to meet a member’s health needs to promote quality, cost-effective outcomes. The APS Case Manager serves a central position as a link between the member, provider(s), the payer, and the community. In this role, the Case Manager seeks to enhance treatment outcomes and reduce the risk of future utilization, while simultaneously containing unnecessary costs. This goal is achieved by decreasing service fragmentation while coordinating benefits of the health care plan.Assess and evaluate relevant member information related to the current treatment plan to identify barriers, to clarify or determine realistic goals and objectives, and to seek potential beneficial alternatives.
Work with the member to develop a treatment plan that enhances outcomes and reduces payer liability. Initiates and implements plan modifications as necessary through monitoring and re-evaluation to accommodate changes in treatment progress. Facilitate communication and coordination of delivery services among all team members including the member, provider and other involved parties.Advocate for the client’s individualized needs and goals throughout the case management process. Educate the client to become empowered and self-reliant by reviewing the optimum coordination of funding, treatment alternatives, timelines, and coordination of health services.Maintain an intimate working knowledge of clinical guidelines (HMS, ASAM, M&R, URAC), and effective use of care management documentation systems. Maintain a strong working knowledge of local and state resources for behavioral health treatment.Facilitate growth in Case Management service delivery and quality by actively seeking to enhance products, services, and department efficiency.Maintain a strong working knowledge of the current customer base and their provider networks.Provide services within the scope of practice defined by current education, certification or licensure, community and published standards.Maintain responsibility for preserving the member’s confidentiality. This includes recognizing that member information is disseminated only per signed release, as mandated by state and/or federal law, and on a need to know basis. A yearly confidentiality statement will be reviewed and signed.Maintain current clinical knowledge and skills through the attendance of seminars, available Internet education, written works, or other similar resources on an annual basis. Contribute time and efforts to the team workload by appropriately organizing daily workload.Organize personal workload and contribute time and effort to the team workload by: Ensuring that phone calls are returned by the next business day Completing all case work and reporting in a timely manner Maintaining a thorough knowledge of and compliance with policies, procedures, and QA requirements Attending and/or participating in the majority of staff/team meetings Identifying, evaluating, and providing feedback on departmental workflows to increase efficiency Participating in Policy and Procedure, QA, and/or other committees as assigned
Maintain compliance with protocols and QA standards. Perform other duties and job functions as assigned.To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functionsVisit our website at:www.apshealthcare.comReferral bonus available to APS Healthcare Employees*
In accordance to guidelinesAPS HEALTHCARE Bethesda, Inc. and its subsidiaries and affiliates (APS) are equal opportunity employers which employ qualified individuals based upon job related qualifications regardless of race, religion, color, sex, national origin, age, disability, or any other classification proscribed under applicable federal, state, or local law. APS complies with the law regarding reasonable accommodation for disabled employees. Applicants requiring reasonable accommodation in order to participate in the interview process are requested to contact Human Resources in order to arrange such accommodation.
REQUIREMENTS
Requirements:
Minimum of three years active patient or clinical experience in a hospital environment is required. Excellent clinical assessment, crisis intervention, and therapeutic skills with mental health and/or substance use disorders. Skilled in balancing clinical and financial issues in care management decisions, adept in directing clinical work teams and gathering critical reporting data.Education:
Bachelor’s (or higher) degree in a health-related field and licensure as a health professional. Certification as a case manager: or RN licensure and three (3) years clinical practice experience.