Case Managers assess, plan, implement, coordinate, monitor and evaluate options and quality health care services for individual consumers. The Case Manager is accountable for collaborating in an individual consumer's specific health care needs in a cost-effective manner, and to empower members to improve their self-management skills in the community. FCHA has adopted the Case Management Society of America (CMSA) principles for our Case Management program. Knowledge domains, competencies and guiding principles may include but are not limited to: care coordination, consumer-centered principles including consumer engagement, collaborative processes to include consumer input and consumer education for shared decision making, The Case Manager follows an Ethical Code of Conduct and CMSA Standards of Practice, assesses the patient's psychosocial aspects of their care, and uses evidence-based guidelines for Case Management practice. The Case Manager provides services across a continuum of care while working within their scope of practice and regulatory requirements.
1. Conducts initial and ongoing evaluation of member's current condition, situation and needs including cultural and linguistic considerations.
2. Interviews client and family and obtains consent for Level III and Level IV case management services.
3. Completes an assessment of the patient's current medical situation, pertinent past medical history, as well as a psychosocial assessment
4. Provides pertinent patient education materials to aid the member in shared decision making.
5. Collaborates with the member, caregiver and their providers to create a prioritized patient centered short to medium term plan to optimize member's self-care management.
6. Collaborates with member, caregiver and appropriate providers to implement the plan, while empowering the member to improve their self-management skills.
7. Monitors and evaluates the effectiveness of the member's case management plan and works with the member to adjust as needed.
8. Encourage positive member behavior change.
9. Facilitates communication and coordination among the health care team to minimize fragmentation, eliminate duplication and maximize delivery of appropriate care.
10. Provides member with referrals: to condition appropriate educational health management programs, to behavioral health providers, as needed, and to resource materials from FCH approved sources.
11. Provides concise, accurate and timely case documentation using FCH applications.
12. Creates member correspondence using plain language and ensuring compliance with internal policies and procedures.
13. Represents First Choice Health Network, Inc. in professional organizations or meetings.
14. Completes month-end updates and case management notes for invoicing by the established date.
15. Identifies and refers patients to behavioral health, stop loss, subrogation, quality and external vendors for health and wellness services based on the appropriate guidelines and payor requirements.
16. Meets established productivity and quality standards.
17. Adheres to department and corporate policies and procedures.
18. Other projects or duties as assigned.
1. Registered nurse required.
2. Current, unrestricted RN license in state of residence and after successfully completing a 90 day orientation period, must begin applications for licensure in (Washington), Idaho, Oregon, Montana, Alaska and South Dakota within 6 months of hire.
3. CCM or related case management certification preferred or in process within 24 months from date of hire.
4. Minimum of five (5) years full time equivalent of direct clinical care to patients.
a Two (2) years of TPA CM experience may be substituted for one (1) year of clinical experience.
b No candidate may have less than three (3) years of full time equivalent of direct clinical care to patients.
5. Strong physical assessment skills.
6. Strong organizational, time management and interpersonal skills.
7. Preferred experience in an HMO, PPO or related health care industry.
8. Proficiency in PC Applications including Word, Excel Outlook, G-Suite, and keyboarding skills.
9. Demonstrates analytical ability to identify problems, develop solutions and implement a course of action within an acceptable interpretation of departmental policies and procedures.
10. Professional demeanor, functions well in stressful situations, and prioritizes well with minimal direction.
11. Excellent problem solving, negotiation and conflict resolution skills.
12. Ability to demonstrate strong written, verbal and interpersonal communication skills with varying levels of internal and external agencies and medical professionals.
1. Ability to see and hear within normal ranges with or without aid.
2. Ability to bend, and move within normal ranges.
3. Ability to be stationary for long periods of time.
4. Finger and hand dexterity.
5. Ability to lift a minimum of 10-20 lbs.
Access to PHI:
Routine & re-occurring access to all forms of PHI - The duties of the position require regular and unrestricted contact with PHI.
Become a First Choice Health employee and enjoy our generous benefit package. We offer competitive benefits that are much beyond the traditional basics.Click here to learn more about our competitive benefit package.
How to Apply
Please submit your resume to [email protected].
Additional information about our company may be found on our website www.fchn.com