Case Management Specialist

The Case Management Specialist works with providers, patients, and insurance companies to help ensure patients receive the highest level of care, assisting them with their chronic care and preventative care needs to help reduce long-term health concerns and hospitalizations. They educate patients on the benefits of recommended preventative care services and build rapport with them to improve patient engagement, self-care management, and adherence to their individualized plan of care. They track patients’ chronic care needs and work with teams within the organization to identify barriers for patients accessing care and link them to community resources. They act as a liaison, collaborating with our community partners and other healthcare organizations to ensure continuity of care and care coordination activity within the EMR.

• LPN/RN license with clinical experience required, or Medical Assistant (MA) certification with a minimum of five years clinical experience in a medical setting.
• Clinical experience with an understanding of chronic disease management and knowledge of all life cycles required.
• Knowledge of Microsoft Excel required.
• Individual must be professional, self-motivated and have strong attention to detail, communication, teamwork, customer service and computer skills.
• Must maintain current CPR for all life cycles.
• Must demonstrate excellent internal and external customer service skills.
• Employee must demonstrate an understanding of the intent, and follow standards, guidelines and protocols related to achieving and maintaining certifications by outside agencies.
  
• Ability to provide bilingual patient care is a plus.
• Must have valid driver's license and reliable transportation.

• Identify patients who are at risk for attribution loss and coordinate care to improve patient engagement and self-care management, while assessing barriers to care.
• Responsible for monitoring emergency room/ discharge reports from the hospital to identify patients in the population and assist in the coordination of services for high-risk patients and focused populations while utilizing appropriate triage protocols.
• Initiate transitions of care visits daily.
• Assist in closing healthcare gaps to improve Uniform Data System (UDS) and Healthcare Effectiveness Data and Information Set (HEDIS) quality measures that align with health system goals.
• Generate a minimum of 750 telephone encounters annually.
  • The Case Management Specialist assigned to Medicare is expected to complete a minimum of 150 Medicare outreach attempts per month (approximately 37.5 calls per week).
• Access electronic medical record (EMR) of referral sources to obtain diagnostic and lab results to update the patient's EMR.
• Act as liaison to community partners and capture care coordination activity within the electronic medical record (EMR) while effectively communicating with the hospital case management team and local skilled nursing facility personnel to facilitate coordination of specific patient care issues.
• Attend a minimum of two community events per year.
• Other duties and tasks as directed by the Case Management Coordinator.
  

ADDITIONAL DUTIES IF ASSIGNED TO CHRONIC CARE:

• Act as a liaison between Chronic Care Management (CCM) vendor and communication with patients and ESRH staff.
• Routinely audit enrollment and monthly calls for quality assurance purposes.
• Ensure all required elements are documented for CCM and related Annual Wellness Visits (AWV) component billing.
• In collaboration with the Health Education Team, schedule and complete Annual Wellness Visits (AWV) or Initial Preventative Physical Exam (IPPE).
  • The Case Management Specialist assigned to Medicare Annual Wellness Visits (AWV) is required to complete at least fifteen (15) AWVs per month.
• Collaborate with community partners to promote Chronic Care Management.
• Scan schedules for eligible patients for the CCM program and promote at point-of-care, based on volume.