Location:

Calmont Operations Building

Department:

STAR/CHIP CM

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Additional Information:

Performs case management activities across the continuum of care in order to promote and facilitate quality, cost effective outcomes and minimize fragmentation of health care delivery for the assigned member population. The Health Plan Case Manager identifies and coordinates short and long term needs of catastrophically/chronically ill and/or injured children/adolescents and their families. Members may have behavioral health conditions, pediatric conditions, high risk pregnancy, targeted chronic conditions or be in need of transition of care services. The Case Manager acts as a member advocate, facilitates communication and coordinates care with physicians, clinics, hospital facilities, family, caregivers and other healthcare providers and implements creative solutions to meet members health care needs without compromising quality outcomes. Expectations also include supporting health risk reduction through behavioral change and patient education. Case Management activities are completed primarily by telephone.

• Master of Social Work degree from an accredited school required.
• Three (3) years experience in a case management role required; five (5) years preferred.
• Competent in Microsoft Office software, general computer knowledge and ability to type and use computers required.
• Knowledge of case management standards of practice, motivational interviewing and supporting behavioral change required.
• Experience with case or disease management in a health plan environment preferred.
• Pediatric experience desirable.
• Bi-lingual (English/Spanish) Preferred. No testing requirement.

• Communicate effectively verbally and in writing.
• Provide excellent telephonic customer service.
• • rganize and prioritize multiple activities.
• Work with individuals from diverse cultural, social and economic backgrounds.

• Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW) current, unrestricted Texas license required.
• Certification in Case Management (CCM) preferred.