Job details
Salary $55,000 - $75,000 a year job type full-time
Full job description
The vision of colorado access is to have healthy communities transformed by the care that people want at a cost we can all affordOur mission is to partner with communities and empower people through access to quality, affordable care.
This specific care manager ii position may work with a variety of medicaid and/or chp+ populations including, but not limited to:
Chp+ complex member sub-populations with a focus on children and youth with special health care needs (birth-19), including complex newborns
Pregnant women
General care management for medicaid and/or chp+ members
Under the supervision of the supervisor or manager of care management, the care manager ii is responsible for completing the appropriate level of care management activities for colorado access membersSpecifically, this position will provide complex care coordination and case management for high acuity members and requires complex clinical decision makingCare management activities will include but will not be limited to completing assessments, determining eligibility, monitoring provider services, coordinating services, developing care plans, delivering care management interventions, appropriate follow up activities and completing all documentation in the expected time frameThe care manager ii will apply appropriate criteria, guidelines, and regulations specific to the level of care and services required to meet the member/family goals and the organizational/contractual requirementsCare management functions may be performed for members in a variety of settings including telephonic, in-person or in the community setting.
Assesses and identifies member strengths, needs, concerns, and preferences through interviewing, observing, and administering structured instruments, to collect data about the member’s health, function, behavior, mental health, cognition, environment, finances, and support system.
Performs advanced clinical assessments and provides clinical knowledge of emotional disorders, chronic health, medication issues, substance use disorders, communicable diseases, and advanced directives.
Establishes goals and care plans with members and their natural supports if applicable.
Implements care plans through coordinating services and interventions by referring, educating, negotiating, and mediating with members and formal or informal providers.
Manages and monitors the ongoing provision of and need for care by monitoring the delivery and quality of services and interventions providedPerforms ongoing monitoring of member status and satisfaction with services and makes adjustments to care plans as needed.
Assists in identification of risk factors leading to increased utilization and works to reduce preventable hospitalizations, readmissions, and inappropriate utilization.
Communicates with members utilizing person centered thinking and language through all aspects of care management.
Establishes professional and effective collaboration, communication, and coordination among all responsible parties of an individual member’s interdisciplinary health care team.
Actively participates in clinical presentations and or/ interdisciplinary team meetings, disposition planning, department meetings, and organizational meetings and communicates progress and barriers with supervisor/manager.
Maintains knowledge and educates members regarding various state plan benefits, programs, options and services.
Responsible for accurate and timely completion of all forms, reports, and documentation of care management activities.
Maintains professional and ethical manner with all interactions and meets performance, quality, customer service, and coordination standards as assigned by the department management team.
Assists members and providers in understanding the complaint, grievance and appeal process.
Participates in training and staff development opportunitiesActively participates in team meetings and communicates progress and barriers with coordinator supervisor and/or department manager.
Requirements:
Education: master’s degree in human behavioral sciences field required and/or clinical license.
Experience: three years of clinical, care management and/or healthcare experience requiredExperience working with medicare and medicaid populations, and related social/economic issues delivering care management services, conducting assessments, interviewing members, developing service plans, coordinating care and monitoring services for members preferred.
Knowledge, skills, and abilities: knowledge of managed care, care management and utilization management is requiredAbility to process high volume of work efficiently with a high level of customer service detailKnowledge of and ability to relate to populations served by the programs for which we work, client interviewing and assessment skills, knowledge of policies and procedures regarding public assistance programs, ability to develop care plans and service agreements, knowledge of resources, and negotiation, intervention, and interpersonal communication skillsDemonstrates support for the company’s mission, vision and valuesPosition requires excellent written and verbal communication skills, strong organizational and time management skills, strong interpersonal skills and the ability to handle multiple prioritiesPosition requires flexibility to use complex processes and procedures to facilitate quality outcomes and/or resolutions while working with other team members with varied skills and educational backgroundAbility to work independently outside of office setting and conducting face to face assessment visitsMust have general computer skills and ability to work with microsoft office productsRequires the ability to use the complaint, grievance and appeals process and procedures to facilitate quality outcomes and/or resolutions for membersMay be required to manage multiple priorities and projects with tight deadlines.
Licenses/certifications: if licensed, a current unrestricted colorado license as a healthcare professional; lpc, lcsw, lmft or rnA valid driver`s license and proof of current auto insurance will be required for any position requiring driving.
Due to the pandemic, our employees are temporarily working at homeWe require our workforce to reside in colorado and telecommute, which may require you to come into the office as we serve our local communitiesThis position will require member facing community based visits as conditions related to the pandemic allow.
Compensation & benefits:
Compensation: $55,000.00 - $75,000.00 annuallyPay rate/salary to be commensurate with experience.
Benefits: in addition to being part of a mission driven organization that serves our community, eligible colorado access employees receive a generous benefits package, including:
Medical, dental, & vision starting the 1st day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Healthcare and dependent care flexible spending account options.
Employer paid basic life insurance and ad&d (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Paid time off
Retirement plan
Tuition reimbursement (based on eligibility).
Annual bonus program (based on eligibility, requirements and performance).
Colorado access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable lawWe strive to maintain a work environment that is free from unlawful harassment and discrimination.
Job type: full-time
Pay: $55,000.00 - $75,000.00 per year
Work location: multiple locations
