Medical Fund Clinical Case Manager

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.

PCG is currently seeking a qualified Case Manager. The Case Manager will be responsible for assisting enrollees of a publicly administered Medical Fund on behalf of a state agency. The Case Manager will be charged with helping program recipients, family members, and caretakers navigate healthcare benefits offered through this Fund. The Case Manager will also be responsible for utilizing a case management software system on a day-to-day basis. The purpose of the Fund is to provide a funding source for future health care costs associated with birth‐related neurological injuries.
The Case Manager will also assist in development of program policies and procedures, and program improvement processes. The Fund operations include, performing assessments, providing case management services, assisting families and program recipients through prior approval of certain healthcare services, and collaborating with the claim’s administration team. Successful candidates will be accountable for the full patient care cycle.

Duties and Responsibilities

• Responsible for helping program recipients, family members, and caretakers navigate healthcare benefits
• Assists in the development of program policies and procedures
• Responsible for the full patient care cycle.
• Assesses, plans, implements, monitors and evaluates actions required to meet the client’s health and human services needed.
• Coordinates and provides care that is safe, timely, effective, efficient, equitable, and client-centered
• Handles case assignments, draft service plans, review case progress and determine case closure
• Travels within the State to conduct periodic in person assessments
• Facilitates multiple care aspects (case coordination, information sharing, etc.)
• Helps patients make informed decisions by acting as their advocate regarding their clinical status and treatment options
• Develops effective working relations and cooperate with medical team throughout the entire case management process
• Interacts with patients to keep track of their progress and to ensure satisfaction
• Records case information, complete accurately all necessary forms and produce statistical reports Promotes quality and cost-effective interventions and outcomes
• Assesses and addresses motivational and psychosocial issues
• Adheres to professional standards as outlined by protocols, rules and regulations

Required Skills

• Excellent communication, interpersonal and client-facing skills.
• Ability to work independently and on a team.
• Proven working experience in case management, including as a nurse, medical, mental health care manager or a related job
• Excellent knowledge of case management principles, healthcare management and reimbursement
• Previous experience with psychological aspects of care
• Effective communication skills
• Excellent organizational and time management skills
• Familiarity with professional and technical emerging knowledge
• Problem solving skills and ability to multi-task
• Compassionate with teamwork skills

Qualifications

• BS degree in related healthcare field preferred
• Experience working with pediatrics; Experience or educational training in health or social services, preferably including work experience or a practicum that involved the performance of assessments and the development of case management plans.
• Current license, certification or registration as a Registered Nurse or Social Worker

Working Conditions

• Remote with some infrequent on site visits.

The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities or skills of personnel so classified.

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Compensation: