Company :

　　Highmark Inc.

　　Job Description :

　　JOB SUMMARY

　　This job serves as the single point of contact for members to coordinate all of the member’s care needs across the various service delivery systems and community supports. This is a full time community based position requiring frequent travel within the assigned territory in DE. The incumbent will travel to members’ homes, nursing facilities, and other community based setting for individuals enrolled in DSHP Plus LTSS.

　　ESSENTIAL RESPONSIBILITIES

　　Travel to members’ homes, nursing facilities, and other community based settings in order to complete face to face needs assessments with subsequent telephonic contact with the member in accordance with state and national guidelines, policies, procedures, and protocols.

　　Assess, plan, coordinate, implement and evaluate care for eligible members with chronic and complex health care, social service and custodial needs in a nursing facility or home and community-based care setting.

　　Coordinate care across the continuum of services and assisting members physical, behavioral, long term services and supports (LTSS), social, and psychosocial needs in the safest, least restrictive way possible while considering the most cost-effective way to address those needs.

　　Facilitate authorization, coordination, continuity and appropriateness of care and services in community or HCBS.

　　Facilitate transitions to alternate care settings such as hospital to home, nursing facility to community setting using an integrated care team to address the member’s specific needs.

　　Educate members or caregivers regarding health care needs, available benefits, resources and services including available options for long term care community or facility-based service delivery.

　　Provide education, resources, and assistance to help members achieve goals as outlined in their plan of care and to overcome obstacles to achieving optimal care in the least restrictive environment.

　　Develop a plan of care in conjunction with members or caregivers to identify services to meet the member’s specific needs, and goals.

　　Identify resources needed for a fully integrated care coordination approach including facilitating referrals to special programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.

　　Collaborate with the member's health care and service delivery team including the DSHP Plus LTSS Member Advocate, ICT, and discharge planners, to coordinate the care needs and community resources for the member in order to maintain the member in the least restrictive safe environment possible.

　　Assist members in developing, implementing and amending a back-up plan for gaps in provider coverage.

　　Ensure approved support services are being provided as outlined in the plan of care.

　　Evaluate the effectiveness of the service plan and making appropriate revisions as needed in accordance with per policy & procedures and state contractual requirements.

　　Assist members in overcoming obstacles to optimal care through connection with community resources, including communicating with providers and formulating an appropriate action plan.

　　Document all case management services and intervention in the electronic health record.

　　Adhere to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards.

　　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

　　Registered Nurse or Licensed Practical Nurse and 2 years of experience in long-term care, home health, hospice, public health, or assisted living OR

　　A high school degree or equivalent and three years of qualifying experience with case management of the aged, including management of behavioral health conditions, or persons with physical or developmental disabilities, or HIV/AIDS population.

　　Substitutions

　　NonePreferred

　　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

　　Working flexible hours to meet member’s needs

　　Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)

　　Reliable transportation daily to be able to travel within assigned territory

　　Ability to meet regulatory deadlines.

　　Has a dedicated home work space used only for business purposes and is able to comply with all telecommuter policies.

　　Experience in geriatric special needs, behavioral health, home health

　　Understanding of the importance of cultural competency in addressing targeted populations.

　　Experience with electronic documentation system(s)

　　Experience with cost neutrality and budgeting

　　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

　　Rarely

　　Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

　　Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

　　As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

　　Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

　　Pay Range Minimum:

　　$57,700.00

　　Pay Range Maximum:

　　$106,700.00

　　Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

　　Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

　　EEO is The Law

　　Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

　　We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

　　For accommodation requests, please contact HR Services Online at [email protected]

　　California Consumer Privacy Act Employees, Contractors, and Applicants Notice

　　Req ID: J237504