Case Manager

TITLE:Case Manager
DEPARTMENT: Health Care Assistance Program
FLSA STATUS: Non-Exempt
REPORTS TO: HCAP Manager

SUMMARY

The Case Manager, functions in a non-hospital setting to assist some of the most complex patient population in navigating the health care system and making it work for them. This role consists of care coordination with multiple providers, explanation of benefits and client education. The Case Manager will also evaluate the appropriateness and medical necessity of medical services, procedures and facilities in line with our Client Handbook and Network Providers.

ESSENTIAL DUTIES AND RESPONSIBILITIESinclude the following:

• Assess clients’ physical and mental wellness, medical needs and abilities using the approved assessment tool.
• Develop tailored care plans with client-initiated goals for each HCAP client. Each goal will have tasks and interventions to be monitored by the Case Manager to ensure progress towards goals. The care plan will be updated at least quarterly and adjusted more frequently as needed.
• Develop and provide appropriate grade level patient education as required, including counseling, education and/or screening for health risks (smoking, weight, high blood pressure, COPD, diabetes exercise, nutrition, cholesterol, and cancer). This may occur in the office and/or in the client’s home.
• Assist clients with obtaining supplies needed to manage their disease and provide access to prescription and medical services when appropriate.
• Reinforce and monitor care plans developed by primary care provider.
• Arrange for HCAP-approved services for clients as needed, such as scheduling tests, locating an appropriate medical provider, reviewing the medical plan, notifying the client, etc.
• Provide clients with information about community resources and relevant physicians’ that are consistent with their needs.
• Work cooperatively with other MCHD programs to provide community education and outreach services as requested, and participate in identification and interpretation of health/social needs in the community.
• Follow-up with discharged clients to ensure satisfaction with services and confirm they are still in good physical and mental health.
• Maintain universal medical precautions in dealing with all clients.
• Research new procedures and information to improve health status of clients and develop program statistics.
• Effectively document all client interaction in electronic format using the I.H.S. software.
• Process and maintain confidential information according to confidentiality policy.
• Complete continuing education required for all licenses and registrations. Attend professional development courses as required and obtain disease specific certifications as needed. Example: become a certified diabetes educator.
• Interface with all internal and external customers in a respectful and responsible manner to enhance relationships and minimize conflict as validated by complaints/feedback and management observation.
• Coordinate schedules with otherCase Manager(s)to adequately provide services to eligible clients; identify relief for vacation periods.
• Other duties as assigned.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

MINIMUM QUALIFICATIONS

• Licensed Health Care Professional with Vocational Nurse (LVN), Registered Nurse (RN) or Paramedic preferred.
• Two (2) years of work experience in chronic illness case management/care coordination preferred.
• Patient education experience preferred.

SKILLS AND KNOWLEDGE

• Proficient word processing, database, and related experience with practice management and/or electronic medical records software.
• Strong verbal and written communication skills.
• Critical thinking and problem solving to determine the best care for each client after assessment and doctor notes review.
• Excellent clinical assessment and analytical skills.

CERTIFICATES, LICENSES, REGISTRATIONS

• Current Texas Driver's License.
• Healthcare License or Certification.
• Remain insurable by the current insurance vendor of MCHD.
• Required NIMS Training as referenced in the Safety & Emergency Management Policy SEM 27-201.

NOTE: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demand Category:

Light Duty: Lifting 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds.

Audio-Visual & licensing Demands:

• Vision (Avg)
• Color Discrimination
• Peripheral Vision
• Depth Perception
• Hearing (Avg)

Required License / Certification: Valid Driver's License

Specific Actions Required: In an eight hour day, this job may include:

• Standing/Walking: 1-4 Hours
• Sitting: 6-8Hours
• Driving: Occasional

Work Environment:This job may include:

• Chemicals
• Cold
• Dampness
• Heat/Humidity
• Noise

Repetitive Motions: This job will include:

• Simple Grasping
• Fine Manipulation
• Pushing & Pulling
• Finger Dexterity
• Foot Movement

MANEUVERABILITY: This job will require:

Frequent:

• Bending
• Reaching

Occasional:

• Squatting
• Climbing
• Twisting