Case Manager I (63304)

Case Manager I (Social Worker or Healthcare Administrator) in the Miami-Dade, FL area. MUST have case management experience withLTC members.

The position is remote but may require 1-2 service days in person to meet providers and the Team. The work scheduled is M-F, 8 : 30am - 5 : 00pm EST.

Bilingual in English / Spanish.

KNOWLEDGE / SKILLS / ABILITIES

• Completes comprehensive assessments of members per regulated timelines.
• Facilitates comprehensive waiver enrollment and disenrollment processes.
• Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and / or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.
• Promotes integration of services for members including behavioral health care and long-term services and supports, home and community to enhance the continuity of care for members.
• Assesses for medical necessity and authorize all appropriate waiver services.
• Evaluates covered benefits and advise appropriately regarding funding source.
• Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration.
• Assesses for barriers to care, provides care coordination and assistance to member to address psycho / social, financial, and medical obstacles concerns.
• Identifies critical incidents and develops prevention plans to assure member's health and welfare.

REQUIRED EDUCATION :

Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or master's degree in a social science, psychology, gerontology, public health or social work OR any combination of education and experience that would provide an equivalent background

REQUIRED EXPERIENCE :

• At least 1 year of experience working with persons with disabilities / chronic conditions and Long Term Services & Supports.
• 1-3 years in case management, disease management, managed care or medical or behavioral health settings.

PREFERRED EXPERIENCE :

• 3-5 years in case management, disease management, managed care or medical or behavioral health settings.
• 1 year experience working with population who receive waiver services.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

Active and unrestricted Certified Case Manager (CCM)

Active, unrestricted State Nursing license (LVN / LPN) OR Clinical Social Worker license in good standing. Valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation