Case Manager, Health Plan

at  Sanford Health

JOB SUMMARY

The case manager provides case management and care coordination for designated Health Plan members. Develops a care plan that includes managing and directing members to appropriate resources, services and programs. Evaluates for comprehensive coordination of care and health services to manage members across the continuum, creates action plans for members and helps them track toward program graduation. Collaborates with the integrated team and partners in order to provide a seamless exchange of information between providers, members and caregivers with the ultimate outcome to improve quality, reduce costs and enhance the member experience.
Conducts member assessments, identifies gaps and interventions, and coordinates ongoing care with physician and integrated team. Coordinate with facilities to assist with discharge planning, aftercare follow-up appointments and transition of care as appropriate. Coordinates and manages medical/behavioral health needs of members across the continuum of care. May perform authorizations for services as indicated for specialty case management. Provides educational resources to member based on medical and behavioral health needs. Serve as a consult on cases for their clinical expertise when they are not the lead case manager. Supports a successful self-management of their long-term health status. Uses internal and external resources to provide quality and cost-efficiency care. Utilizes motivational techniques to promote member engagement.
Possesses strong clinical knowledge and skills. Collaborates with team members both internally and externally to ensure care is coordinated and appropriate based on evidence based medicine. Must be self-motivated with the ability to work independently, a problem solver and fiscally responsible.
Ability to work independently or as a member of a team. Ability to multitask and work with little direction. Works primarily day hours. Works primarily telephonically in an office environment and onsite as needed. Travel may be required as necessary.

QUALIFICATIONS

Depending on area of focus, education, experience and licensure differs.
Bachelor’s degree in nursing required.
Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE). Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA) is strongly preferred.
OR
Master’s degree in counseling, social work, marriage and family therapy or psychology required.
Graduate from a nationally accredited behavioral health program. Accreditation from (CACREP) Council for Accreditation of Counseling and Related Educational programs. Accreditation from (COAMFTE) Commission on Accreditation for Marriage and Family Therapy Education, or (CSWE) Council of Social Worker Education.
Nursing:
Will consider applicant with significant background in case management, transplant services and/or other utilization review experience. Minimum of three years nursing experience is required.
Behavioral Health:
Will consider applicant with significant background in case management or specialized clinical experience. Minimum of five years behavioral health experience is required.
Must have knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM) V, and American Society of Addiction Medicine (ASAM) criteria.
Nursing:
Currently licensed with the applicable state nursing board and/or possess multistate licensure privileges as required by position. Current Commission for Case Manager Certification (CCMC) is preferred or is to be obtained within two years of employment.
Behavioral Health:
Currently licensed with the applicable behavioral health board or appropriate regulatory board and/or possess multistate licensure privileges as required by position.

Please refer the Job description for details