SUMMARY

Community Health Net Case Manager works to facilitate patient care by assessing patient needs, evaluating treatment options, creating treatment plans, coordinating care, and gauging progress. Case Managers work with physicians, social workers, families, and human services providers. The overall goal for the Case Manager is to improve clinical outcomes, increase patient satisfaction, and promote cost-effectiveness.

QUALIFICATIONS/REQUIREMENTS

• Associate degree in behavioral health and/or healthcare related field preferred.
• Certified Application Counselor with the Federal Insurance Marketplace preferred.
• Working knowledge of the Pennsylvania Medical Assistance Program, CHIP, and the COMPASS benefit application is preferred. Degree in Social Work, Public Health, Public Administration, or similar field from an accredited college or university preferred.
• Required to achieve and maintain certifications required by the Affordable Care Act as they relate to Certified Application Counselor designation.
• Ability to use computers and Windows based software to enter data and develop reports as needed.
• Must be responsible, precise, and organized.
• Knowledge of medical terminology required.
• Knowledge of behavioral health protocols and laws related to higher level care.
• May be required to work evenings, weekends, and some holidays based upon operational need.

• Accomplishes patients’ care by assessing treatment needs; developing, monitoring, and evaluating treatment plans and progress; facilitating interdisciplinary approaches.
• Admits new patients by reviewing records and applications, conducting orientations.
• Determines patients’ requirements by completing intake interviews; determining need for therapeutic medical, psycho-social, and psychiatric evaluations; reviewing therapist evaluations, treatment objectives, and plans.
• Establishes treatment programs by setting schedules and routines; coordinating services being provided; arranging resources, including transportation and escort.
• Monitors cases by verifying patients’ attendance; observing and evaluating treatments and responses; advocating for needed services and entitlements; obtaining additional resources; intervening in crises; providing personal support.
• Provide application and renewal assistance and facilitate enrollment (including but not limited to completing applications, gathering required documentation, and troubleshooting the enrollment process) in a health insurance program by providing fair, impartial, and accurate information.
• Maintain knowledge and expertise in eligibility, enrollment, and program specifications of the Medicaid and CHIP programs and have some basic knowledge of the Qualified Health Plans (QHP) in the Health Insurance Marketplace.
• Conduct structured in-reach, outreach and education activities to existing health center patients and community residents to promote awareness about coverage options under Medicaid, CHIP, and the Marketplace, engage in follow-up conversations and offer enrollment and renewal assistance to individuals.
• Maintains patients’ records by reviewing case notes, logging events and progress.
• Communicates patients’ progress by conducting weekly interdisciplinary meetings and evaluations; disseminating results and obstacles to therapeutic team and family; identifying treatment influences.
• Prepares patients’ discharge by reviewing and amplifying discharge plans; coordinating discharge and post-discharge requirements; orienting and training family members; providing resources.
• Improves treatment results by studying, evaluating, and re-designing processes; implementing changes; rewriting policies and procedures.
• Prepares reports by collecting, analyzing, and summarizing treatment and results data and trends; compiling statistics; completing grant and subsidy applications.
• Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Enhances department and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
• Perform other job-related duties as directed.