Case Manager Long-term Care - Delaware, New Castle County - RN at Highmark Health in Working at Home, DE

Job description

Company : Highmark Inc. Job Description : JOB SUMMARY New Castle County territory - Registered Nurse This community-based Case Manager position is responsible for delivering comprehensive case management services to DSHP Plus LTSS and DSNP members. The role requires frequent travel within an assigned territory for home or site visits to assess member needs, develop and implement care plans, evaluate benefits, coordinate services, and monitor progress. A key aspect of the position is to ensure quality and cost-effective care by preventing improper utilization of member benefits. ESSENTIAL RESPONSIBILITIES Comprehensive Member Assessment: Conduct thorough assessments of members' health status, needs, and resources through in-person visits and ongoing phone support, managing a caseload with moderate complexity. Individualized Care Plan Management: Develop, implement, and monitor individualized care plans that address physical, behavioral, custodial, social, and psychosocial needs with minimal guidance. Holistic Service Coordination: Coordinate access to appropriate services, community resources, and specialists, ensuring efficient and cost-effective delivery across care settings. Member Advocacy: Serve as a primary advocate, guiding members and caregivers through healthcare decisions, and helping them overcome barriers to achieve care plan goals. Care Transition & Continuity: Ensure seamless and appropriate care transitions between hospitals, community settings, and facilities. Outcome Evaluation: Continuously monitor member progress, evaluate the effectiveness of services, and proactively adjust care plans to optimize outcomes. Cost & Quality Improvement: Identify opportunities for cost savings, quality improvement, and workflow efficiencies in care delivery. Regulatory Adherence: Ensure all documentation and activities strictly comply with business processes, company policies, regulatory requirements, and accreditation standards. Benefit Maximization: Coordinate member benefits across all payor sources and actively work to prevent improper utilization of benefits. Perform other duties as assigned/requested. QUALIFICATIONS Required Bachelor's degree in Social Work or in health, human, or education services and 3 years of experience in long-term care, home health, hospice, public health, or assisted living OR Master’s degree in Social Work or in health, human, or education services and 1 year of experience in long-term care, home health, hospice, public health, or assisted living OR Current State RN or LPN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) and 2 years of experience in long-term care, home health, hospice, public health, or assisted living. Substitutions None Preferred One year in home clinical or case management experience Certified Case Manager (CCM) Licensed Bachelors Social Worker (LBSW) Licensed Masters Social Worker (LMSW) Licensed Clinical Social Worker (LCSW) Experience working with HIV/AIDS population Experience working with behavioral health population Experience working with developmental disabilities population Medicare and Medicaid experience Managed care experience SKILLS Strong assessment and care planning skills. Ability to work independently and as part of a team. Proficiency in using Microsoft suite of applications, case management software and electronic health records. Time management abilities Understanding of healthcare systems and case management principles Language (Other than English): None Travel Requirement: 25% - 50% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Works From Home Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarel