CLINI002870
**Priority will be given to Washington State Residents**
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:
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About the Role
Assists with and coordinates care management activities under the direction of an RN or LICSW Case Manager, Supervisor, or Manager. Functions as an interdependent team member in the areas of member assessment, planning, facilitation, and advocacy.
To be successful in this role, you:
- Possess a Bachelor’s degree in social work, Practical Nursing Certificate, or an equivalent bachelor’s degree in a relevant health care field. Candidates with a bachelor’s degrees in a relevant health care field must have a minimum of (1) year experience in care coordination or care management either in a managed care organization, community-based organization, or related workplace preferred
- Have previous experience as a medical assistant, behavior health technician, or other social welfare services or an equivalent combination of education and highly relevant experience preferred or valid Washington State Licensed Practical Nurse (LPN).
- Have a minimum of one (1) year of clinical and/or care management experience (required)
- Have proficiency and experience with Microsoft Office products
- Knowledge of Medicare and Medicaid regulations
- Have one (1) year in care management in a health plan, community agency or Accountable Care Organization (ACO) (preferred)
- Have knowledge of care management systems and planning techniques
- Have experience in care management workflow systems (preferred).
Essential functions and Roles and Responsibilities:
- Communicates with providers to arrange follow up appointments, obtain clinical records, and assist members with care coordination
- Ensures appropriate coordination of services to members such as any necessary member transportation needs, obtaining community resources such as food pantries and housing.
- Coordinates and facilitates services with physical and behavior health care providers within an episode of care.
- Documents and manages the care management process to include case identification, assessment, planning and goal prioritization, monitoring, support, and case closure.
- Participates in clinical outcome data monitoring and collection.
- Assess member health care status and health (medical, behavioral, and social) history, risks, gaps and utilization.
- Develops plans of care with appropriate member centric interventions.
- Provides behavioral health support and interventions to members in crisis.
- Collaborates with member PCP, specialists, and community resources/vendors to leverage community resources
- Ensures all care coordination activities are documented medical record system per established guidelines.
- Support staff in answering member calls including participation in the 5pm call rotation for crisis calls.
- Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
Knowledge, Skills, and Abilities:
- Organizational, time management, and project management skills
- Knowledge of medical terminology, electronic medical records, developmental disability services, special education IDEA/ADA and healthcare process (preferred)
- Understanding and experience with health care systems, regulations, policies, functions, and documentation standards
- Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers
- Comfortable presenting in a group setting
As part of our hiring process, the following criteria must be met:
- Complete and successfully pass a criminal background check
Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.
- Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
- Vaccination requirement (CHPW offers a process for medical or religious exemptions)
- Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
Compensation and Benefits:
The position is FLSA Non-Exempt and is eligible for overtime. Based on market data, this position grade is 45 and has a 5% annual incentive target based on company, department, and individual performance goals.
CHPW offers the following benefits for Full and Part-time employees and their dependents:
- Medical, Prescription, Dental, and Vision
- Telehealth app
- Flexible Spending Accounts, Health Savings Accounts
- Basic Life AD&D, Short and Long-Term Disability
- Voluntary Life, Critical Care, and Long-Term Care Insurance
- 401(k) Retirement and generous employer match
- Employee Assistance Program and Mental Fitness app
- Financial Coaching, Identity Theft Protection
- Time off including PTO accrual starting at 17 days per year
- 40 hours Community Service volunteer time
- 10 standard holidays, 2 floating holidays
- Compassion time off, jury duty
Sensory/Physical/Mental Requirements:
Sensory*:
- Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.
Physical*:
- Extended periods of sitting, computer use, talking, and possibly standing
- Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
Mental:
- Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.
Work Environment:
Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
