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About the Role

The Care Manager I (CMI) provides comprehensive care coordination services to members enrolled in the Health Services for Children with Special Needs (HSCSN) health plan. This role involves assessing member needs, developing and monitoring treatment plans, and coordinating care for members with moderate to complex medical and psychosocial needs.

Responsibilities

• Manages a caseload as outlined by CASSIP and Care Management Leadership.
• Maintains compliance with contractual and care management requirements.
• Contacts enrollee at predetermined intervals based on stratification level or more frequently, as needed.
• Conducts face-to-face visits at a frequency determined by the enrollee’s assigned stratification level or more if needed, with each enrollee/caregiver in their homes, physician’s offices, or other mutually agreed upon locations.
• Assesses enrollees on enrollment and at intervals determined by the enrollee’s stratification level to identify needs/barriers and close gaps in care.
• Identifies over/under utilization promptly, and takes appropriate action according to organizational policy.
• Develops, implements, and updates an accurate individualized comprehensive care plan for each assigned enrollee in collaboration with the PCP and/or other multi-disciplinary team members including public agencies.
• Completes routine care coordination and care management activities with attention to quality, timeliness and in compliance with company policy and national standards.
• Consults with Senior Care Manager to review and prioritize cases, set objectives, identify, and report potential risk and utilization concerns.
• Seeks advice from Senior Care Manager or other designated person with expertise in specialty areas when necessary.
• Accurately and timely documents enrollee findings and interactions according to organizational policy.
• Receives supervision by licensed staff according to oversight guidelines.
• Understands and abides by HSCSN’s Confidentiality policy and procedure regarding enrollee specific information.
• Participates in disposition and discharge planning activities.
• Contributes to the discharge plan in a timely manner, taking into consideration enrollee/family/significant others and match to healthcare resources.
• Clearly communicates verbally and in writing.
• Assists/empowers caregivers or enrollees to participate in care of child /self.
• Assists assigned enrollees and their caregivers in understanding the importance of EPSDT and compliance with all health services.
• Strives to achieve target rate of compliance for preventive medical and dental services.
• Assists with scheduling and monitors the compliance of mental health/medical appointments.
• Follows department policies for identifying and reporting noncompliance, missed appointments, and other reportable incidents including communication to primary care provider or specialist.
• Applies advanced knowledge of conditions of target population/standard approaches to care management and care coordination to assigned enrollees.
• Attend multidisciplinary meetings as necessary, including off-site meetings with other involved agencies.
• Receives and reviews reports of visits by vendors or contracted providers to enrollees receiving services and facilitates coordination of follow-up care, as needed.
• Refers enrollee/caregiver to appropriate vendor(s) on DME/assistive technology use.
• Educates on medication administration, about their conditions, and techniques for self-management within the scope of license.
• Refer, as needed, to appropriate vendor for additional education.
• Assist enrollees in planning for transitions of care to include but not limited to transitioning from Early Intervention to DCPS; from pediatric to adult providers; transitioning out of HSCSN when the enrollee ages out or is disenrolled for any reason; from outpatient to inpatient or the reverse; and entering or exiting the custody of CFSA, DYRS or any type of institutional care.
• Enters authorizations for services requiring authorization by Care Management staff.
• Keeps abreast of changing strategies and trends in care coordination and care management.
• Uses communication skills which promote understanding and collaboration with enrollees and their families, HSCSN staff, providers and others.
• Positively presents accurate information about HSCSN to enrollees and their families, HSCSN staff, providers, coworkers and the community.
• Maintains professional, courteous and customer focused demeanor in all interactions.
• Demonstrates knowledge of medical terminology and health care delivery systems.
• Applies time management and organizational skills effectively.
• May perform other duties in addition to those outlined in this job description.

Requirements

• Graduate Social Worker Licensed in DC as a Licensed Graduate Social Worker (LGSW) (Required)
• Two or more years of healthcare or related experience in managed care and /or care management (Preferred)
• Two or more years experience in clinical or community resource settings (Preferred)

Skills

• Effective verbal and written communication skills
• Bilingual (Spanish speaking) preferred
• Familiar with medical terminology
• Proficiency with computer systems and applications, particularly in Microsoft Office suite
• Strong organizational skills
• Ability to interpret and apply departmental requirements
• Ability to make sound decisions and use good judgment
• Ability to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
• Ability to participate in professional, multidisciplinary meetings to include internal and external staff meetings

Experience Level

• 2 years of healthcare or related experience in managed care and /or care management (Preferred)
• 2 years experience in clinical or community resource settings (Preferred)

Education Level

• Master's Degree (Required)

Salary/Compensations

• $65,124.80 - $108,555.20

About the Company

• Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.
• Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.

Equal Opportunity

• The “Know Your Rights” poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster.