Working Each Day to Make a Difference
At Community Health Plan of Washington, we’re driven by our belief that everyone deserves access to quality health care.
More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.
We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.
- We are a local not-for-profit health plan in Washington State.
- We are committed to keeping Washington families healthy.
- We connect our communities to the health resources they need.
- We provide access to high-quality care for our members.
- We connect and empower our members through technology.
- The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
- Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.
To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org.
Field Case Manager I - King County
This position is Remote; however, the candidate will need to reside in and travel throughout the King County region.
POSITION PURPOSE:
Responsible for the operational delivery of the plan’s case management and coordination programs and processes. Provides case management services for CHPW members with short-term, long-term, stable, unstable, and predictable course of illness, and/or highly complex medical/behavioral and social conditions. The goal is to improve members' quality of life and ensure cost-effective outcomes by using internal and community-based resources.
PRINCIPAL DUTIES:
- Advocates on behalf of and facilitates coordination of resources required to help members reach optimum functional levels and autonomy within the constraints of their disease conditions.
- Work on a multi-interdisciplinary care team that collaborates with providers, members, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs and ensure access to appropriate services to achieve positive health outcomes.
- Assesses, evaluates, plans, implements, and documents the care of members within the organizations’ clinical database system in accordance with organizational policies and procedures.
- Responsible for the assessment of members, including identifying and coordinating access to the appropriate level of care and treatment. Uses the assessment information to assign the appropriate risk and complexity level, create and document a care plan in coordination with the member, family/caregiver and provider input.
- Initiates a plan of care based on member-specific needs, assessment data and the medical/behavioral plan of care.
- Plans care in collaboration with members of the multidisciplinary care team, and considers the physical, behavioral, cultural, psychosocial, spiritual, age specific and educational needs of the member in the plan of care.
- Reviews and revises the plan of care with the interdisciplinary care team to reflect changing member needs based on evaluation of the members’ status, and/or because of reassessment.
- Implements the plan of care through direct member care, coordination, and delegation of the activities of the health care team. Promotes continuity of care by accurately and completely communicating to health care team the status of members for whom care is provided. Engages community resources where applicable.
- Conducts interdisciplinary care team meetings with the member/family/caregiver to assess care plan and recommend adjustments as indicated.
- Continuously evaluate members’ progress towards goals, identify potential barriers to attaining goals and expected outcomes in collaboration with the interdisciplinary care team.
- Participates in activities that lead to quality patient outcomes through timely, effective, efficient, equitable, and safe care.
- Documents all case activity using the CHPW care management system and follows documentation standards and protocols.
- Provides Transition of Care (TOC) if a member is hospitalized. This includes participating in care conferences and other d/c planning activities that may be needed to prevent a readmission.
- Provides face-to-face visits to members where telephonic case management is a barrier, to foster effective participation in the case management program.
- Serves as a liaison at various local and statewide meetings and/or workgroups and provides clinical support to providers to enhance integrated care coordination.
- Assesses barriers to care and assists members in navigating the healthcare system and utilizes the interdisciplinary care team to address concerns.
- Supports compliance with NCQA accreditation standards.
- Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion
QUALIFICATIONS:
Education & Prior Related Experience:
- Possess a bachelor’s degree in nursing or master’s degree in social work and/or related behavior health field (preferred)
- Have a current, unrestricted license in the State of Washington as a registered nurse (RN) (required) OR
- Have a current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC) (required) OR
- Have a current, unrestricted license in the State of Washington as a Mental Health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required)
- Have a current, unrestricted driver’s license in the State of Washington
- Have a minimum of one (1) year case management, home health or discharge planning experience; OR a combination of education and experience which provides an equivalent background OR
- Have minimum of one (1) year facility-based medical or behavioral health experience and/or outpatient psychiatric and substance abuse/substance abuse disorder treatment experience, required; or equivalent combination of education and experience and/or working with children and families. Experience with those who have disabilities and knowledge of Child and Families Services
- Have three (3) years of clinical experience in an acute care and/or outpatient setting (required)
- Proficiency and experience with Microsoft Office products
Preferred
- Have a case management certification
- Are bilingual
- Have managed care (Medicaid and/or Medicare Advantage) experience
- Have previous experience using Care Management software applications (preferred)
Employment Eligibility:
- Candidate has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
Knowledge, Skills, and Abilities:
- Knowledge of, and experience with, community resources (i.e. Regional Centers, Washington State Medicaid mental health and substance abuse services) (preferred)
- Knowledge of regulatory and certification requirements and their impact on the organization (for example, HEDIS, CAHPS, and NCQA).
- Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians, allied health care providers, community partners and other staff members
- Organizational, time management, and project management skills
- Ability to work independently
- Knowledge of Medicare and Medicaid regulations
- Willing and able to provide face-to-face visits to members when barriers to telephonic case management are identified for effective outreach and engagement in case management program
To apply, please visit: https://www.chpw.org/contact-us/chpw-careers/
We're committed to our employees and their family, which is why we offer benefits that, makes a difference in their lives. Paid time off, tuition reimbursement, community service hours, and transportation perks are just a few of the offerings of our comprehensive and competitive benefits program.
Community Health Plan of Washington is an Equal Opportunity Employer with a diverse workforce!
Headquarters: 1111 3rd Avenue, Suite 400 Seattle, WA 98101