Licensed Case Manager

Job Description

Description:

V-Tech Solutions, Inc. is looking for Licensed Case Managers to support our client! We are currently looking for Social Workers and Registered Nurses. The qualified candidate will be detailed oriented and passionate individuals who are ready to provide the best possible care and service to those in need in the D.C. area. Under the direction of the Supervisory Case Manager, the Case Manager (CM) is responsible for providing comprehensive coordination services to enrollees. The CM routinely communicates with members on their assigned caseload to assess their needs; develop, monitor, and evaluate treatment plan progress; and assist with coordinating care and referring to appropriate services for members who have moderate to complex medical and psychosocial needs.

Job Responsibilities Include:

Managing a caseload as outlined by CASSIP and Care Management Leadership

Maintains compliance in accordance with contractual and care management requirements

Contacts enrollee at predetermined intervals based on stratification level or more frequently, as needed

Conducts face-to-face visits at a frequency determined by the enrollee’s assigned stratification level or more if needed, with each enrollee/caregiver in their homes, physician’s offices, or other mutually agreed upon locations

Assesses enrollees on enrollment and at intervals determined by the enrollee’s stratification level to identify needs/barriers and close gaps in care

Identifies over/under utilization promptly and takes appropriate action according to organizational policy.

Upon gathering health and mental/behavioral health, environmental, psychosocial, and educational information, the CM develops, implements, and updates an accurate individualized comprehensive care coordination plan for each assigned enrollee in collaboration with the PCP and/or other multi-disciplinary team members including public agencies

Completes routine care coordination and care management activities with attention to quality, timeliness and in compliance with company policy and national standards

Consults with Supervisory Care Manager to review and prioritize cases, set objectives, identify, and report potential risk and utilization concerns

Seeks advice from Supervisory Care Manager or other designated person with expertise in specialty areas when necessary

Accurately and timely documents enrollee findings and interactions according to organizational policy

Participates in disposition and discharge planning activities. Contributes to the discharge plan in a timely manner, taking into consideration enrollee/family/significant others and match to healthcare resources

Assists assigned enrollees and their caregivers in understanding the importance of EPSDT and compliance with all health services. Strives to achieve target rate of compliance for preventive medical and dental services

Applies advanced knowledge of conditions of target population/standard approaches to care management and care coordination to assigned enrollees

Refers enrollee/caregiver to appropriate vendor(s) on DME/assistive technology use. Educates on medication administration, about their conditions, and techniques for self-management within the scope of license. Refer, as needed, to appropriate vendor for additional education.

Assist enrollees in planning for transitions of care to include but not limited to transitioning from Early Intervention to DCPS; from pediatric to adult providers; transitioning out of the program when the enrollee ages out or is disenrolled for any reason; from outpatient to inpatient or the reverse; and entering or exiting the custody of CFSA, DYRS or any type of institutional care

E/O/E

As an applicant, a request can be made to view V-Tech's Affirmation Action Plan Data. Please contact to request an appointment.Requirements:

Requirements:

MUST be Licensed in DC as a Social Worker (LICSW, LGSW, or RN)

Master’s Degree Required

3 years of experience in healthcare or related experience in managed care and/or care management

3 years of experience in clinical or community resource settings

Effective verbal and written communication skills

Bilingual (Spanish speaking) preferred

Familiar with medical terminology

Familiarity with computer systems and applications, particularly in Microsoft Office suite

Strong organizational skills

Ability to interpret and apply departmental requirements.