Complex Case Manager (Remote with field travel in Greater Columbia region)

This position is a hybrid of remote from home and field work. The candidate will need to reside in and travel throughout the Greater Columbia Region (Yakima, Kittitas, Benton, Franklin, Walla Walla, Garfield, Columbia, Asotin and Whitman counties) 

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to apply an equity lens to all our work. 
• Reduce health disparities. 
• Become an anti-racist organization 
• Create an equitable work environment. 

About the Role

This position works under the general direction of the Manager of Case Management and is responsible for the the plan’s regional care management coordination programs and processes. The Case Manager will provide case management services for CHPW members with short term, long term, stable, unstable, and predictable course of illness. This role also provides case management services for CHPW members with highly complex medical/behavioral and social conditions where advocacy and coordination are required. This role represents CHPW during regional meetings regarding care management / care coordination, including presenting / speaking at these meetings. The Case Manager coordinates with the CHPW Regional Manager to provide external representation at community and program-based meetings and initiatives.

To be successful in this role, you:

• Possess a Bachelor’s degree in nursing or a master’s degree in social work and/or a related behavior health field (required)
• Have a current, unrestricted license in the state of Washington as a registered nurse (RN) (required) OR
• Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required) OR
• Current, unrestricted license in the State of Washington as a Mental health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required)
• Have a minimum of one (1) year of case management experience (required)
• Have a minimum of two (2) years of experience in use of care management workflow systems; NCQA standards; and experience meeting with, and presenting to, organizations (required)

Preferred

• Have a case management certification
• Are bilingual
• Have experience in managed care (Medicaid/HCA)
• Have previous experience in using Care Management software applications
• Have knowledge of, and experience with, community resources

Essential functions and Roles and Responsibilities:

• Coordinate all case management services within assigned areas in order to assure appropriate coordination of services to CHPW members.
• Perform the primary functions of assessment, planning, facilitation and advocacy through collaboration with the member and other health care resources involved in the member's care.
• Representation of CHPW Care Management Department at regional meetings
• Research meeting agenda and planned topics for effective representation.
• Effectively prepare and design presentations for regional meetings
• Present information on Care Management programs to regional stakeholders, and brings back information to CHPW
• Collaborate with HSD / CHPW leadership for presentation preparation
• Follow up with appropriate department leadership for any commitments / requests that came from meetings
• Work with providers (specialists, CHC, community resources) and vendors to implement programs and monitor health outcomes of case managed members (both complex and non-complex).
• Responsible for assessment (HRA) review of members assigned and appropriateness of the level of care and treatment and participate in clinical outcome data collection. Perform other pertinent condition specific assessments as indicated
• Develop member interdisciplinary care plans in conjunction with the member's PCP, specialists, and community resources/vendors..
• Coordinate with family and caregivers as appropriate.
• Coordinate the interdisciplinary/integrated approach to providing continuity of care including, working with the utilization management, TOC teams to assist in transfer coordination, and discharge planning, whenever applicable.
• Maintain case management records within the Jiva system.
• Exempt – Employees are expected to report to work as