Allegiance Benefit Plan Mgmt.
  • 20-Jan-2016 to 01-Aug-2017 (MST)
  • Missoula, MT, USA
  • Full Time

REPORTS TO: Case Management Services Manager    LOCATION: Missoula, MT         FSLA STATUS: Exempt

POSITION RESPONSIBILITIES:


The Case Manager (CM) evaluates medical care alternatives for cases of illness, injuries or medical/surgical diagnoses that require extensive services. These cases may require acute rehabilitation, in-patient hospitalization, or preventive care in an attempt to avoid future complications or admissions. The role of the CM is to facilitate quality health care by decreasing fragmentation, enhancing patient's quality of life, while containing costs, resulting in more effective outcomes. The CM will foster positive working relationships, both within StarPoint and with StarPoint's external customers.

The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and be respectful and courteous in the conduct of this position.

ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.

1. The Case Manager will:


• Assess, plan, implement, coordinate, monitor, and evaluate the treatment plan and/or develop alternative options, taking into consideration the medical and psychosocial needs of the patient throughout the continuum of care. The CM will identify and establish short and long-term goals in collaboration with the patient, the patient's healthcare team, and the Plan.
• Develop and implement a treatment plan taking into consideration the patient's needs, resources available, and time frames for response to referrals, and to follow-up and evaluate the effectiveness and cost of the plan of care.
• Act as patient advocate by speaking directly with the patient to discuss alternatives and identify treatment implications, and then maintain ongoing contact to monitor compliance and effectiveness of the treatment plan.
• Coordinate services and assess progress and outcomes. Modify the plan and goals as the patient's needs change by creatively and proactively identifying solutions using the resources available, maximizing benefits and services at all levels of care by meeting established criteria, performing utilization review with accurate and thorough documentation.
• Provide education on the disease process, treatment options and costs. Reduced costs may be derived by utilization of participating providers, care networks, the negotiation of costs of services and/or supplies, and the limitation of unnecessary services.
• The CM will refer to the Health Care Advisor any case where there is a question of quality of care, questions on the disease process, and/or treatment plan in place.
• Contribute to the daily workflow with regular and punctual attendance.

2. The Case Manger must communicate, verbally and in writing, clearly and effectively with team members, patients, patients' families, health care providers, physicians and customers, both "internal and external."

3. The essential job functions identified below will be evaluated through peer review, discussions with HealthCare Advisors, and random file review by the supervisor to ensure that all QA requirements are met.


4. The Case Manager must promote nursing professionalism:
• Works to maintain current clinical knowledge and skills through attendance of seminars, accessing of available education through the internet and/or journal reviews as evidenced by a documented log of ten (10) CEU's annually.
• Understands responsibility in preserving the patient's confidentiality. This includes signing of an annual confidentiality statement and recognition that patient information is used only for purposes necessary for conducting case management.
• Effective professional communication skills to all parties involved, (i.e.: listening, written, verbal).
• Must be flexible to changing situations and needs.

5. The Case Manager organizes work load and contributes time and efforts to the team work load and responsibilities as evidenced:
• Prompt return of phone calls within 24 hours or the next business day.
• Daily review of all new referred cases and actions plans implemented.
• Completing all case work and reporting in a timely manner in compliance with policies and procedures.
• Attendance and/or participation in the majority of team meetings.
• Identifying and/or providing feedback on department workflows to increase efficiency.
• Participation in Policy and Procedures, CEU, and/or QA committees as assigned.

6. The Case Manager must be able to operate a personal computer, copier, fax machine, and telephone. Must be able to access, research, and extract information from printed resources, computer terminals, medical records, and telephone interviews on a daily basis. This will be evidenced by demonstration of skills during random observations.

NON-ESSENTIAL JOB FUNCTIONS:

1. Preparation of forms, faxing, copying.
2. Organization of files and reference materials.
3. Ability to operate typical office equipment and working knowledge of basic office principles.

PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.

JOB SPECIFICATIONS:

To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Licensure: Bachelors degree or higher in a health-related field and
licensure as a health professional
or
RN Licensure and three (3) years clinical practice experience
Certified Case Manager certification required, may be obtained after hire date.
Other Experience: Must possess organizational skills and the ability to prioritize multiple tasks, attend to detail and follow through to completion.

Allegiance Benefit Plan Mgmt.
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