Medical Case Manager

Want to be a part of an amazing organization? An organization that makes a difference in the lives of individuals each and every day?

Monroe Plan for Medical Care is a not-for-profit health care services organization that has been meeting the needs of our members in the Greater Buffalo, Rochester, Syracuse, Albany and Binghamton Regions for over 50 years. Monroe Plan provides health home services and other critical health care services to individuals covered by Medicaid, Child Health Plus and the Essential Plan.

Following our mission and vision to improve the health status of individuals and families, Monroe Plan's innovative clinical care management programs are structured to meet the unique needs of members, providers, health care organizations and the communities we serve. Monroe Plan has consistently been recognized as a national leader in the "safety net" area, with a proven track record of improving health outcomes and reducing disparities by supporting a health care delivery system that ensures the availability of high quality medical care for all.

Medical Case Manager

Grade 307

This position requires occasional travel throughout Erie County and Monroe County.

This is a full time position, working from home.

The minimum and maximum annual salary that Monroe Plan believes in good faith to be accurate for this position at the time of this posting are $60,949 - $78,362. In addition to your salary, Monroe Plan offers a comprehensive benefits package (all benefits are subject to eligibility requirements) and non-monetary perks. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

POSITION SUMMARY

Provide case management to adult members with high risk or complex medical and psychosocial problems through community and home based visits, and telephonic support. Provide linkage to appropriate care services, and communicate with providers in order to reduce health disparities and improve health care outcomes. Provide oversight of member support activities performed by outreach representatives and social work staff on a case specific basis. Develop and implement targeted initiatives based on member preference and disease states that promote improved health care outcomes and quality of life.

ESSENTIAL JOB DUTIES/FUNCTIONS

% of Time

Essential Function

70%

Provides Case Management Services. Under the direction of the Manager or Clinical Coordinator, the Case Manager will:

• Provide case management to members with high risk or complex medical and psychosocial problems through community and home based visits and telephonic support.

• Provides linkage to appropriate community resources, referral to appropriate care services, and communicate with providers in order to reduce health disparities and improve health care outcomes.

• Acts as an advocate for members to assure access and service delivery across the continuum of care and community resources.

• Develops and implements targeted initiatives based on knowledge and expertise in clinical practice and disease states that promote improved health care outcomes and quality of life.

• Meet regulatory and agency policy and procedures related to the practice and documentation of case management activities.

• Demonstrate strong interpersonal skills in order to handle difficult situations in a professional and courteous manner.

• Handles confidential information in accordance with HIPPA , state and federal confidentiality rules.

20%

Communication

• Interacts, as appropriate, with other internal and external agency staff. Attends team meetings, trainings, and other functions, as assigned by manager.

• Presents and expresses information in an organized, understandable and complete manner. Able to positively influence others.

10%

Reporting and Back Up

• On a monthly basis, review charts for regulatory compliance and address errors/omissions

• Assist manager in the collection and reporting of metrics for reporting to internal/external entities.

Total must equal 100% - essential functions should be completed at least 10% of the time

OTHER FUNCTIONS AND RESPONSIBILITIES

• Identifies opportunities to improve processes and services. Shares with Manger and Clinical Services Leadership issues that are obstacles to providing great service.

• Performs other duties as assigned.

MINIMUM REQUIREMENTS/LICENSES/CERTIFICATIONS

• A current Professional Nursing or Social Work License is required.

• A minimum of 2 years' experience in medical case management and 2 years' recent acute care and/or community health nursing with knowledge of community resources, health care services, treatment planning and discharge planning.

• Effective and diplomatic oral communication skills. Good listening skills.

• Sound reasoning and problem solving skills.

• Strong computer skills.

• Ability to read, understand and follow written policies and procedures.

• Ability to learn new skills.

• Ability to interact with individuals with diverse cultural and religious customs.

• Must have a NYS driver's license and car for community travel.

• Specialized Case Managers have additional minimum requirements based on specialty area.

PREFERRED QUALIFICATIONS

• Experience in insurance industry. Managed Medicaid experience a plus.

• Experience in Case Management delivery.

PHI MINIMUM NECESSARY USE: This staff position PHI access will be determined based on Minimum Necessary standards. The Minimum Necessary Grid can be found on the Human Resources and Compliance Web pages.

This job description is only a summary of the typical functions of the job, not an exhaustive or comprehensive list of all possible job responsibilities, tasks and duties.

Additional responsibilities, tasks and duties may be assigned as necessary.

Monroe Plan for Medical Care is an Equal Opportunity Employer.