Regional Field Case Manager I Southwest Region (MSW/RN)

This position is a hybrid of remote work from home and field work. The candidate will need to reside in and travel throughout the Spokane region (Ferry, Stevens, Pend Oreille, Lincoln, Spokane, and Adams counties).

About the Role

This position works under the general direction of the Supervisor of Care Management and is responsible for the plan’s regional field care management and coordination programs and processes. The Regional Field Case Manager will provide care management services for CHPW members with short-term, long-term, stable, unstable, and predictable courses of illness. The Regional Field Case Manager resides within the assigned region to effectively coordinate care between members, providers, and community resources. This role also provides care management services for CHPW members with highly complex medical, behavioral, and social conditions where advocacy and coordination are required. This role represents CHPW in the community to provide education on care management programs and in-person support for members. The Regional Field Case Manager coordinates with internal and external partners to support members, providers, and initiatives in the assigned region.

Requirements

• Possess a Bachelor’s degree in nursing or a master’s degree in social work and/or a related behavioral health field (required).
• Have a current, unrestricted license in the state of Washington as a registered nurse (RN) (required) OR
• Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required) OR
• Current, unrestricted license in the State of Washington as a Mental Health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required).
• Minimum of one (1) year case management experience; home health or discharge planning experience; or a combination of education and experience which provides an equivalent background required OR
• Minimum of one (1) year in an acute care, facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse disorder treatment experience, required; or equivalent combination of education and experience and/or working with children and families.
• Experience with those who have disabilities and knowledge of Child and Families Services.
• Minimum three (3) years of clinical experience and/or outpatient setting (required).
• Valid state-issued driver’s license.

Preferred Qualifications

• Case management certification.
• Bilingual.
• Experience in managed care (Medicaid/HCA).
• Previous experience in using Care Management software applications.
• Knowledge of, and experience with, community resources.
• Experience in care management workflow systems.

Responsibilities

• Engages with members, providers, and agencies in the assigned region to support field care management services.
• Provides face-to-face visits to members where telephonic care management is a barrier, to foster effective participation in the care management program.
• Identifies and partners with emergency response services or other programs in a community that support members who are high utilizers of medical/behavioral health services.
• Field case management can include meeting members in acute care, emergency room, adult family home, inpatient behavioral health facilities, shelters, community health centers, members' homes, or member-preferred locations.
• Assesses, evaluates, plans, implements, and documents the care of members within the organization’s clinical database system in accordance with organizational policies and procedures.
• Implements the plan of care through direct member care, coordination, and delegation of the activities of the health care team.
• Promotes continuity of care by accurately and completely communicating to the health care team the status of members for whom care is provided.
• Evaluates members’ progress towards goals, identifies potential barriers, assists members in navigating the healthcare system, and sets expected outcomes in collaboration with the member and the interdisciplinary care team.
• Works within the multi-interdisciplinary care team that collaborates with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs, and ensure access to appropriate services to achieve positive health outcomes.
• Advocates on behalf of members and facilitates coordination of resources required to help members reach optimum functional levels and autonomy within the constraints of their disease conditions.
• Represents CHPW Care Management Department in the community to provide education on care management programs and collaborate with providers and community partners.
• Leads regional-based projects as assigned.
• Participates in external care conferences and other discharge planning activities that may be needed to prevent readmission as needed.
• Participates in clinical case review with internal interdisciplinary team at Care Management Rounds.
• Reports to work as scheduled, participates in all assigned meetings, and meets established performance and accountability standards.
• Other duties as assigned.

This position requires traveling on behalf of the Company and working in the field at least 50% of the time. It is essential that a current driver’s license, proof of insurance, and an acceptable driving record are maintained.

Skills

• Knowledge of regulatory and certification requirements and their impact on the organization such as CMS, HCA, HEDIS, CAHPS, and NCQA.
• Knowledge of and experience with community and other resources.
• Analytical skills and the ability to interpret, evaluate, and formulate action plans based upon data.
• Organizational, time management, and project management skills.
• Ability to handle multiple priorities.
• Ability to multi-task and deal with complex assignments on a frequent basis.
• Proficiency and experience with Microsoft Office products.
• Written and verbal communication skills; able to communicate with and collaborate effectively with internal departments, physicians, and allied health care providers.
• Ability to work independently.
• Perform all functions of the job with accuracy, attention to detail, and within established timeframes.
• Ability to maintain confidentiality.

Benefits

The position is FLSA Exempt and is not eligible for overtime, with a 10% annual incentive target based on company, department, and individual performance goals.

• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• PTO accrual starting at 17 days per year
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty

Sensory/Physical/Mental Requirements

Sensory: Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical: Extended periods of sitting, computer use, talking, and possibly standing. Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.

Mental: Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively, and meet time-sensitive deadlines.

Work Environment

Office environment. Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.

Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.
• Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/or employees.
• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions).