Sr. Care Manager

Summary/Position Objectives:
Under the direction of the Director, Medical Management provides case management to identified high-risk members that require medical intervention and monitoring. This position is responsible for the coordination of all aspects of the patient’s care and services. The Case Manager is responsible for assessing, evaluating, planning, and coordination of medical treatment and health care for members requiring support related to catastrophic illness; mental, social or physical disabilities; a high rate of recidivism; social, cultural and language barriers; inability to manage their medical condition; or any member who can benefit from the assistance of a qualified liaison. The goal is to assure the member has access to medically necessary quality care in a judicious and timely manner.

Responsibilities:
Essential Functions:
Assists in developing, maintaining and monitoring processes to promote the timely identification and assessment of designated members.
Serves as interdisciplinary team member in management of identified members, performing clinical/social - status assessments and in collaboration with physicians, determining medical needs of members.
Conducts telephone interviews of members to identify risk factors and the need for case management.
Initiates, develops, plans and implements care plans designed to promote the delivery of quality care and service to members.
Utilizes clinical judgment to discharge members from case management according to Schaller Anderson Healthcare’s policies and procedures.
Maintains case management record according to Schaller Anderson Healthcare’s Policies and procedures and ensures data integrity in the information systems.
Collects, evaluates and reports clinical, functional and program activity as applicable.
Identifies cases to assess for impact of case management services; may assist in the collection of data.
Educates members' providers regarding the members' needs to ensure consideration is given to the unique needs of the patients in treatment planning.
Coordinates and communicates with community support and social service systems for special needs for our members.
Serves as a point of contact and resource for members, providers and peers.
Assists with educational training to contracted providers, members and SAA staff regarding the health care benefits, policies and regulations governing the populations served.
Assists with development of policies and procedures related to case management of the population.
Communicates effectively with supervisor/manager with regard to departmental issues, member issues, program status, compliance issues, and quality of care concerns, etc.

Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The company’s suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in America’s core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.

The VISION of Schaller Anderson, Inc. is to be recognized as the nation’s foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.


BENEFITS:

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k) and profit sharing
* Tuition reimbursement
REQUIREMENTS
Knowledge and Skills:
Proficiency with Microsoft Office Suite applications and common computer and office hardware is necessary.
Ability to perform mathematical skills and calculate simple statistics accurately.
Working knowledge of case management software such as CaseTrakker?.
Effective written and oral communication skills.
Effective problem solving, organizational and time management skills with the ability to consistently work in a fast-paced environment.
Ability to type 45 words per minute.

Education and Work Experience:
RN (BSN preferred), or MSW with “active, unrestricted” license in the state of California.
Minimum of three years’ experience in hospital/non-hospital patient care environments and/or Public Health, Home Health or Community Health providing services to clients within the home setting. Must have experience helping members using community agencies.
Case management experience, or at least one year of experience in Utilization Management, Quality Management or Risk Management.