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Description : $10,000 sign on bonus available 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.
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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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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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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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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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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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The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review.
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