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GENERAL OVERVIEW:The Social Work Case Manager in Care Management is a professional clinician that utilizes principles of care coordination to support patients and their families/caregivers. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on appeals in accordance with our regulatory guidelines.
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Provides appropriate documentation and follow up to physician offices, case management department, and payors regarding authorization/referral deficiencies. Description : GENERAL OVERVIEW:Completes one or more of the following processes (scheduling, pre-registration, financial clearance, authorization and referral validation and pre-serviceability estimations and collections) within Patient Access and creates the first impression of AHN's services to patients and families and other external customers.
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Identify resources needed for a fully integrated care coordination approach including facilitating referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
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The overall goal is to help members navigate the health care system and develop condition self-management skills through behavior changeESSENTIAL RESPONSIBILITIESFunction as a primary contact for members with Opioid Use Disorder (OUD)/Behavioral Health with co-morbid medical conditions including pregnancy to provide intensive case management interventions.
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Description : JOB SUMMARYThis job provides telephonic integrated behavioral and physical health case and condition management services to members with mental health, substance use, and co-morbid chronic medical conditions.
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Description : GENERAL OVERVIEWThe Medical Director will provide qualified medical direction and consultation for care delivery and complex case management for our community-based palliative care program.
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Accurately use logic and reasoning in identifying alternate solutions, conclusions or approaches to problems. The role will provide oversight of physician services by complementing the primary care physician, acting as a medical resource to the interdisciplinary group, assuring continuity of care, establishment of goals of care, care plans and through patient centered evaluation and engagement.
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The medical director will partner with the APP, RN and SW as needed to interact/ communicate with the primary care physician as necessary for appropriate medical care. May be required to obtain licensure in additional states after hirePreferredBoard certification in geriatric medicine or hospice and palliative careSKILLSHighly motivated with exceptional organizational skills, including the ability to effectively and competently handle multiple responsibilities simultaneously and the flexibility and ability to quickly adapt to changes in work objectives, promotions, and available technology.
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Superior communication skills to lead the team in care coordination across multiple settings on the care continuum. Leads with a customer and clinician-centric lens and advocates for a combined customer and clinician view in all interactions.
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Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.
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In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management.
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The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals.
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Description : JOB SUMMARYThis job implements effective complimentary utilization and case management strategies for an assigned member panel. For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.
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Implement care management review processes that are consistent with established industry, corporate, state, and federal law standards and are within the care manager’s professional discipline. EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ()We endeavor to make this site accessible to any and all users.
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case job Company: Highmark Health in Windsor-mill, Maryland
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