Description:
The Medicaid Managed Care Comprehensive Case Manager will play a critical role in the Healthy Opportunities Pilot (HOP) Program, which addresses social determinants of health such as housing, transportation, and food security for Medicaid recipients. The Case Manager will provide comprehensive case management services, coordinate care, and ensure the effective delivery of program services to improve health outcomes for vulnerable populations in Swain, Jackson, and Graham counties.
Typical functions include but are not limited to the following:
- Client Assessment and Enrollment:
- Conduct comprehensive assessments to identify the needs of Medicaid recipients.
- Enroll eligible clients into the HOP program and develop individualized care plans.
- Care Coordination:
- Coordinate with healthcare providers, social service agencies, and community organizations to ensure clients receive necessary services.
- Schedule and manage appointments, transportation, and other support services.
- Service Delivery:
- Monitor the implementation of care plans and adjust services as needed.
- Provide direct assistance with housing, transportation, food security, and other social determinants of health.
- Data Management:
- Maintain accurate and up-to-date client records using program-specific data management systems.
- Track and report on client outcomes and program effectiveness.
- Advocacy and Support:
- Advocate for clients' needs within the healthcare system and with social service providers.
- Offer continuous support and follow-up to ensure client satisfaction and program success.
- Community Engagement:
- Engage with community stakeholders to build partnerships and resources for clients.
- Participate in community outreach and educational activities to promote the HOP program.
- Compliance and Reporting:
- Ensure compliance with all program policies, Medicaid regulations, and privacy laws.
- Prepare and submit regular reports on program activities and outcomes to the Program Director.
Qualifications/Requirements:
- A bachelor's degree in social work, public health, nursing, education, psychology, or a related field is preferred. Associated degrees accepted.
- At least 2 years of experience in case management, social work, education, or a related field.
- Experience working with Medicaid populations and understanding social determinants of health is highly desirable.
- Must be at least 18 years of age.
- Strong assessment and care planning skills.
- Excellent communication and interpersonal skills.
- Ability to work independently and as part of a multidisciplinary team under the Executive Director.
- Proficiency in data management and reporting.
- Valid driver’s license and reliable transportation (a vehicle is provided to employees with a safe driving record)
- Ability to travel within Swain, Jackson, and Graham counties.
Performance Standards
- Meet or exceed client enrollment and service delivery targets.
- Maintain high levels of client satisfaction and positive health outcomes.
- Ensure accurate and timely documentation and reporting.
- Demonstrate effective coordination and collaboration with community partners.
- A peer evaluation as well as a quarterly evaluation by the Executive Director will guide performance reviews and targets.
Disclosures
Equal Opportunity Employer:
Restoration House WNC is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Medicaid Compliance:
This position requires adherence to all Medicaid rules and regulations, including maintaining client confidentiality and compliance with the Health Insurance Portability and Accountability Act (HIPAA).
Background Check:
Employment is contingent upon successful completion of a background check.
Training and Continuing Education:
Employees must complete required training and continuing education to maintain compliance with Medicaid guidelines and enhance professional skills.
Interested candidates should submit their resume and references to restorationhousewnc31@gmail.com by June 5th, 2024.
Job Types: Full-time, Part-time
Pay: $30,000.00 - $40,000.00 per year
Expected hours: 40 per week
Benefits:
- Opportunities for advancement
- Paid time off
- Paid training
- Parental leave
- Professional development assistance
- Tuition reimbursement
Schedule:
- Day shift
- Monday to Friday
- Rotating weekends
Experience:
- Human Service: 1 year (Preferred)
Work Location: In person