We are Looking for experienced Case Manger. Must have active RN (Registered Nurse) or LSW License.
Location : Cincinnati, OH 45246
Job title: Case Manager I
Duration: 03 Months With possible extension
Day to day responsibilities: Contact members to complete assessments, create care plans, and provide support for needs with community resources.
Responsible for health care management and coordination of Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes.
• Works with members to create and implement an integrated collaborative plan of care.
• Coordinates and monitors members progress and services to ensure consistent cost effective care that complies with Molina policy and all state and federal regulations and guidelines.
Essential Functions: •
• Provides case management services to members with chronic or complex conditions including:
• Proactively identifies members that may qualify for potential case management services.
• Conducts assessment of member needs by collecting in-depth information from client information system, the member, members’ family/caregiver, hospital staff, physicians and other providers. Identifies, assesses and manages members per established criteria.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs.
• Evaluates effectiveness of the care plan and modifies as appropriate to reach optimal outcomes.
• Measures the effectiveness of interventions to determine case management outcomes. •
• Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for members. •
• Conducts face to face or home visits as required. •
• Strong analytical skills and Knowledge of applicable state, and federal regulations. •
• Knowledge of ICD-9, CPT coding and HCPC. • SSI, Coordination of benefits, and Third Party Liability programs and integration. •
• Familiarity with NCQA standards, state/federal regulations and measurement techniques. •
• In depth knowledge of CCA and/or other Case Management tools. •
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). •
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
• Bachelors degree in Nursing or Masters degree in Social Work, or Health Education (a combination of experience and education will be considered in lieu of degree).
• Required Experience: 0-2 years of clinical experience with case management experience.
• Required Licensure/Certification: Active, unrestricted State Registered Nursing license or Licensed Clinical Social Worker LCSW or Advanced Practice Social Worker APSW in good standing.
• A combination of experience and education will be considered in lieu of LCSW or APSW.
• Must have valid drivers license with good driving record and be able to drive locally.
Established in 1991, Collabera is a leading, global, end-to-end information technology consulting, services and solutions company. Collabera focuses on helping businesses “bridge the execution gap” and experience accelerated business performance. Its client-centric philosophy, commitment to service excellence and a Collaborative Engagement Model enables its global 2000 and leading mid-market clients to succeed in today’s global digital economy. With over 6000 professionals operating from 19 locations and 3 delivery centers worldwide, Collabera provides onsite, offsite and offshore technology consulting, services and solutions to leading Financial Services, Technology, Communications & Media, Energy & Utilities and Manufacturing, Retail & Logistics corporations. The privately held company has offices in the U.S., Europe, and India.
Role: Case Manager/ RN / Licence Social Worker/ Registered Nurse
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