Pediatric Lead Care Manager

Description

Reviews data and interviews potential members and own families to verify eligibility for enrollment in the ECM, and completes referral process when necessary.

  • Conducts appropriate member assessments telephonically and/or in-person.
  • Conduct in-person member meetings on a monthly basis.
  • Responsible for coordinating with individuals and/or entities to ensure a seamless experience for the member and family and non-duplication of services.
  • Oversee provision of ECM services, including the completion of member assessments, development of member Care Management Plans (CMP), provide educational and community resources.
  • Offer services where the pediatric member lives, seeks care, or finds most easily accessible and within Managed Care Plan (MCP) guidelines and connect member to other community services and supports he/she may need, including transportation.
  • Partners with healthcare professionals, community and social support services, and other healthcare entities to coordinate care and locate member resources.
  • Documents evidence of care in the member’s EHR record concisely and abides by all deadlines.
  • Whenever needed, accompany members and families to office visits to serve as an advocate.
  • Communicates and collaborates with providers and care teams, regarding the members' progress and care needs.
  • Identifies, coordinates, and follows-up on member referrals to ensure continuity of care, and member needs are being met.
  • Reassesses care plans to ensure effectiveness in achieving desired outcomes for members and their family.
  • Investigates and directs members’ and families’ inquiries or complaints to appropriate staff members and follows up to ensure satisfactory resolution.
  • Follows established policies and procedures and attend all trainings.
  • Maintains knowledge of community services and resources available to the pediatric members including housing resources, financial/income assistance, transportation assistance and food assistance.
  • Facilitates care transitions between providers, partners, and referral sources and specialty care providers.
  • Follows established protocol around patients experiencing pain, safety concerns and/or mental health concerns and creates safety plans, if necessary.
  • Recognizes signs of child abuse and reports appropriately to Children Protective Services.
  • Understands and abides by all departmental and companywide policies and procedures.
  • Complies with all safety and injury prevention policies and regulations.
  • Performs other duties as assigned or required.
  •  

    Position Requirements: Bilingual (Spanish)

    • High School Diploma 1 year of experience as a medical assistant, certified nursing assistant, home health, hospice, care management, or any other healthcare field.

      Equivalent combination of education and experience that provides the skills, knowledge, and ability to perform the essential job duties, and which meets any required state or federal certification requirements.

    • Language: Fluent in English (written and verbal). Bilingual in Spanish.
    • License/certification:

    o Current and valid Driver’s License and proof of auto insurance.

    o Current BLS certification from the American Heart Association upon start date.

    • Skills required:

    o Competent with computers, email, virtual platforms, MS Excel, MS Word, MS PowerPoint, MS Outlook, and other Microsoft Office based programs.

    o Excellent verbal and written communication skills, including the ability to convey and exchange information in a clear, effective manner.

    o Ability to work independently and carry out assignments to completion within the parameters of established policies and procedures

    Physical Requirements: Physical demands associated with office work, including but not limited to:

    • Consistently operating a computer and other office equipment such as a telephone, calculator, copy machine, and printer.
    • Must be able to remain in a stationary position 75% of the time.
    • Must be able to move around the office or visit members 25% of the time.
    • Frequently moving or carrying office equipment weighing up to 15 pounds across offices.
    • Ability to operate a vehicle and/or travel to meetings and different office locations as required or requested.

    Travel:

    • This is a Hybrid role - LCMs are required to travel to their members within their designated assignments when conducting visits with clients in the field.
    • Eligible for mileage reimbursement for the use of your vehicle for business-related expenses.

    Benefits:

    • This is a Hybrid role working from home while still servicing members in person. All members must be met in-person!
    • Medical, Dental and Vision Insurance
    • We cover up to 100% of your premium and 50% of your dependent premium depending on the plan!
    • Flexible Spending Accounts, Health Savings Accounts & Dependent Care Accounts are also available!
    • Life, AD&D and Short-Term Disability Insurance funded 100% by Titanium Healthcare
    • 401(k) plan
    • Employee Assistance Program
    • 11 Paid Holidays, 3 weeks of all-inclusive PTO per year (accrual begins on the first day of employment) as well as a separate Paid Sick Time balance


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