Birmingham, Alabama
Phoenix, Arizona
Houston, Texas
Birmingham, Alabama
California
Posted: 15-Mar-23
Location: Nationwide
Type: Full Time
Salary: Annual: $68,400 - $131,400
Salary Details:
Preferred Education:
Additional Information:
Internal Number: R26054
This is a work from home opportunity!
Who we are
Case Managers work within a team of interdisciplinary trained and licensed clinicians including registered nurses, licensed behavioral health clinicians, dieticians and support staff providing case management, care transition management and other specialized services.
We are a member facing team and are under the division of Integrated Health Management.
Who we serve
We provide a holistic model which involves collaboration with members and their families, caregivers, employer groups and providers. Case Managers use an integrated (physical/mental health) case management program and a collaborative, relationship-based approach, to assist poly-chronic and high-risk members to improve health outcomes. We utilize a comprehensive, whole person health assessment of member's current situation and status, identify actionable barriers and obtainable goals to achieve optimal self-care management, and monitor members’ progress toward goals. We facilitate coordination, communication, and collaboration among the members’ providers to advocate for members, while promoting member long term self-management and advocacy. We actively assist members to obtain appropriate quality care within their benefit plan and identify resources in the community or within the member's natural support system to fill any gaps within their benefit plan.
Our teams use Motivational Interviewing (MI) techniques, a method which involves asking thoughtful, purposeful questions. Motivational Interviewing works by activating the members’ own motivation for change, which can empower, and fuel personal motivation and confidence needed to pursue change.
What you will do:
- Engage members with medical, mental health and/or substance utilization disorders in health support services utilizing evidenced-based engagement skills.
- Conduct initial holistic health assessment of member's current conditions, situation and needs and perform ongoing evaluations. Assessment will include evaluating the members’ social determinants of health (SDOH) and cultural influences on health care practices.
- Collaborate with the member, caregivers, and providers to develop a member centric case management plan that addresses barriers and promotes improved health outcomes.
- Monitor and evaluate the effectiveness of the member's case management plan and continuously update to ensure goals are progressing and remain pertinent; identify and address barriers to completing goals.
- Facilitate communication and coordination among the health care team to minimize fragmentation, eliminate duplication, and maximize delivery of appropriate care.
- Provide interventions focused on removing the members’ barriers to health improvement, promoting positive behavior change using motivational interviewing techniques, and addressing the caregiver's needs in order to stabilize the members’ natural support systems.
- Maintain concise, accurate and timely documentation that supports effective, efficient management of the member and that meets accreditation, contractual and legal requirements.
What you will bring:
- Registered Nurse or Master's/Doctoral degree in health or human services related field (e.g., Social Work, Marriage and Family Therapy, etc.) (Required)
- Current state credential (e.g., licensure) that allows the professional to conduct an assessment independently as permitted within the discipline's scope of practice: (Required)
- For nurses, required registration and licensure (e.g., RN ARNP)
- For behavioral health, required licensure (e.g., LMFT, LICSW, LPC, LMHC). (Required)
- Have Certified Case Manager (CCM) certification or obtain certification within 24 months of hire (Required)
- 3 years' experience with direct patient/clinical care post licensure. (Required)
- Motivational interviewing experience highly preferred.
- Prior experience as a Case Manager highly preferred.
- Integrated Case Management certificate (ICM), Chemical Dependency Professional (CDP).
- High Speed Cable, DSL or Fiberoptic Internet, no less than 20 mbps – Satellite and Wireless connections will not work with our equipment. (Required)
Training
Premera provides extensive training including initial and ongoing motivational interviewing skill development and assists personal health support clinicians and managers in earning their Chronic Care Professional (CCP) certificate, Integrated Case Manager (ICM) certificate, as well as their Certified Case Manager (CCM) credential. Premera is NCQA accredited program earning full credit for our case management program for the past two audits. As such, all our clinicians receive documentation, assessment, and intervention skill training to ensure they are practicing at the highest professional skill level. Clinicians and managers also employ LEAN methodology that supports their active involvement in process improvement activities.
Schedule
This team requires 5 hours each week between 5pm – 7pm PST Monday - Friday or Saturday 9am – 2pm PST (Pacific Standard Time) to provide extended coverage to members.
