11 jobs found

Position WCF has an immediate opening for someone who can demonstrate the WCF values to join their team as the  Manager, Medical Case Manager  reporting to the Director, Managed Care. This is a hybrid position based in our Sandy, UT office. Responsibilities Supervise, support, monitor and evaluate the performance of the telephonic case management (TCM) and field case management (FCM) teams to ensure the team meets performance and quality standards. Assist the director of managed care, claims services. Develop, implement, and oversee the internal TCM and FCM programs to facilitate the injured worker's recovery through coordination of medical services, return to work options and to control medical, disability and litigation costs. Identify issues related to delayed recovery, identify opportunities to expedite care for cost containment, use creative thinking to problem solve and provide recommendations for alternative clinical resources to support timely recovery and return-to-work. Provide leadership, training, coaching, claim-referral triage, and case/task assignments to the nurse case managers. Coordinate case management referrals to outside vendors, review performance, and assess cost containment outcomes to make amendments, as needed. Ensure program-level metrics are maintained and shared with stakeholders, including claims adjusting and catastrophic-claim reviews. Ensure internal staffing, service model, and vendor partnerships are positioned to deliver quality and scalable service in alignment with company growth. Coordinate nursing and other professional in-house education. Serve as a medical resource for internal contacts. Maintain strong professional working relationships with internal and external contacts. Maintain all required continuing education records and documentation. Serve on committees and special projects as assigned. Accountable for injured worker privacy and confidentiality in accordance with HIPAA regulations. Maintain certifications and RN licensure. Qualifications Bachelor's degree in nursing or equivalent experience. Graduate of an accredited RN program and current Utah RN license. At least one national certification, CCM or CRRN, or other as approved. At least five years' clinical experience, nurse case management experience, and senior supervisory experience. At least three years of experience in ICU/critical care, rehabilitation, orthopedics, home health, community health, occupational health or related field. Thorough knowledge of workers' compensation claims and medical recovery process. Strong cost containment background, such as utilization review or managed care. Exceptional communication (verbal and written), negotiation, and computer-systems skills and technical aptitude. Demonstrated leadership, organizational, and management skills. An internal candidate should have six months, should have acceptable job performance and must notify their current supervisor that they've applied for the position. WCF INSURANCE DE&I MISSION Promote and embrace a diverse, inclusive, equitable, and safe workplace. WCF INSURANCE IS AN EQUAL OPPORTUNITY EMPLOYER WCF Insurance provides equal employment opportunity to all qualified applicants and employees regardless of race, color, religion, sex, age, national origin, veteran status, disability that can be reasonably accommodated, or any other basis prohibited by federal, state, or local law.

Position WCF has an immediate opening for someone who can demonstrate the WCF values to join their team as a  Medical Case Manager  reporting to the Manger, Medical Case Management. This is a home-based position in Weber County, UT with appointments along the Wasatch Front (Ogden, SLC, Provo) and may have occasional travel to surrounding areas. Responsibilities Provide on-site nurse case management services (or telephonically as appropriate) to injured workers with complex or catastrophic injuries. Utilize the nursing process and implement the case management process in day-to-day case-management work activities. Attend injured worker medical appointments with community healthcare providers and coordinate all medically approved services. Provide documentation of medical rehabilitation plan, progress, and recovery. Work closely with medical providers to facilitate care. Serve as a medical resource to claims adjusters, vocational rehabilitation counselors, legal department. Maintain RN licensure and continue to enhance learning of industrial injuries through regular attendance at WCF continuing-education events. Qualifications Graduate of an accredited RN program with current Utah license At least three years of clinical experience in critical care, rehabilitation, orthopedics, home health, or community or occupational health At least one year of nurse case management experience, preferred Knowledge of workers' compensation system Excellent verbal and written communication skills Valid Utah driver's license Bilingual proficiency in English and Spanish is a plus An internal candidate should have six months, should have acceptable job performance and must notify their current supervisor that they've applied for the position. WCF INSURANCE DE&I MISSION Promote and embrace a diverse, inclusive, equitable, and safe workplace. WCF INSURANCE IS AN EQUAL OPPORTUNITY EMPLOYER WCF Insurance provides equal employment opportunity to all qualified applicants and employees regardless of race, color, religion, sex, age, national origin, veteran status, disability that can be reasonably accommodated, or any other basis prohibited by federal, state, or local law.

Job Description Bilingual Spanish/English Required This is a telework role, but candidates must be licensed in the state of CA. Working schedule: Monday-Friday, 8am-5pm. Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. Position Summary/Mission Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Fundamental Components • Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. • Uses clinical tools and information/data review to conduct an evaluation of member’s needs and benefits. • Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. • Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. • Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. • Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences • Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Pay Range The typical pay range for this role is: Minimum: 26.59 Maximum: 57.21 Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location. Required Qualifications – Bilingual Spanish/English Required – 3+ years of clinical practical experience as an RN – Registered Nurse with active CA state license in good standing Preferred Qualifications – 2+ years of case management, discharge planning and/or home health care coordination experience – Experience working with adult and senior populations – CCM preferred – Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually – Excellent analytical and problem-solving skills – Effective communications, organizational, and interpersonal skills. – Ability to work independently – Effective computer skills including navigating multiple systems and keyboarding – Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, and Outlook Education – Associates degree required – Bachelor’s degree preferred Business Overview Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

We are currently seeking Care Managers to serve members in Johnston county. This position will allow the successful candidate to work a primarily remote schedule which includes coming into the Alliance Johnston office (Smithfield, North Carolina) one day per week. The Care Manager II position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues Assist individuals/legally responsible persons in choosing service providers; ensuring objectivity in the process Consistently evaluates appropriateness of services and ensures implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification Utilize person centered planning, motivational interviewing and historical review of assessments in Jiva to gather information and to identify supports needed for the individual Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services and trouble shoot until authorization is obtained.  Notify providers of successful authorization Provide Support and Monitoring Schedule initial contact with member to verify accuracy of demographic information.  Update inaccurate information from the Global Eligibility File Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services  Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance. Refer members who are in crisis/institutional care settings and require assistance with returning to community-based services, to the Integrated Health Consultant Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment Coordinate with other team members to ensure smooth transition to appropriate level of care. Attend treatment meeting with member, natural supports and selected providers.    Schedule, coordinate and lead team conference calls on behalf of member needs Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.  Verify that ongoing service adherence is maintained through monitoring.  Complete Documentation Obtain and upload all supporting documentation, Legally Responsible Person (LRP) verification, and release of information that will improve care management activity on behalf of the member Open new episodes in JIVA and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Escalate complex cases and cases of concern to Supervisor. Distribute surveys to members in service. Ensure that service orders/doctor’s orders are obtained, as applicable.   Share appropriate documentation with all involved stakeholders as consent to release is granted.  Obtain releases/documentation and provides to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency documentation standards, and Medicaid requirements Minimum Education & Experience Master’s degree from an accredited college or university in Human Services or related field and at least two years of full-time, post graduate degree, MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience and active, valid NC clinical licensure as a LCSW, LCMHC, LPA,  or LMFT Or Graduation from a school of nursing with valid NC licensure as a Registered Nurse and two years of full-time MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience. Physical Health experience preferred Special Requirements Active Drivers License RN, LCSW, LCMHC, LPA,  or LMFT Knowledge, Skills, & Abilities Person Centered Thinking/planning Knowledge of using assessments to develop plans of care Knowledge of Diagnostic and Statistical Manual of Mental Disorders Knowledge of LOC process, SIS for IDD and FASN assessment for TBI Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefits plans Knowledge of and skilled in the use of Motivational Interviewing Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.) Strong interpersonal and written/verbal communication skills essential, including  Conflict management and resolution skills High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. Ability to make prompt, independent decisions based upon relevant facts Salary $50,865.49  to $ 87,563.63/Annually

Description We are currently seeking Care Managers to serve members in Mecklenburg or Wake county.      This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work certain days of the week as approved by their supervisor. The Care Manager II position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues Assist individuals/legally responsible persons in choosing service providers; ensuring objectivity in the process Consistently evaluates appropriateness of services and ensures implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification Utilize person centered planning, motivational interviewing and historical review of assessments in Jiva to gather information and to identify supports needed for the individual Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services and trouble shoot until authorization is obtained.  Notify providers of successful authorization Provide Support and Monitoring Schedule initial contact with member to verify accuracy of demographic information.  Update inaccurate information from the Global Eligibility File Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services  Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance. Refer members who are in crisis/institutional care settings and require assistance with returning to community-based services, to the Integrated Health Consultant Recognize and report critical incidents and provider quality concerns to supervisors and Quality Management Complete activities in JIVA related to Plans of Care developed from the Care Management Comprehensive Assessment Coordinate with other team members to ensure smooth transition to appropriate level of care. Attend treatment meeting with member, natural supports and selected providers.    Schedule, coordinate and lead team conference calls on behalf of member needs Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.  Verify that ongoing service adherence is maintained through monitoring.  Complete Documentation Obtain and upload all supporting documentation, Legally Responsible Person (LRP) verification, and release of information that will improve care management activity on behalf of the member Open new episodes in JIVA and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Escalate complex cases and cases of concern to Supervisor. Distribute surveys to members in service. Ensure that service orders/doctor’s orders are obtained, as applicable.   Share appropriate documentation with all involved stakeholders as consent to release is granted.  Obtain releases/documentation and provides to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency documentation standards, and Medicaid requirements Minimum Education & Experience Master’s degree from an accredited college or university in Human Services or related field and at least two years of full-time, post graduate degree, MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience and active, valid NC clinical licensure as a LCSW, LCMHC, LPA,  or LMFT Or Graduation from a school of nursing with valid NC licensure as a Registered Nurse and two years of full-time MH/SUD and or Intellectual/Developmental Disabilities (I/DD) experience. Physical Health experience preferred Special Requirements Active Drivers License RN, LCSW, LCMHC, LPA,  or LMFT $50,865.49  to $ 87,563.63/Annually

We are currently seeking Care Managers to serve members in Mecklenburg county.      The Care Manager I position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work certain days of the week as approved by their supervisor. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments. Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities.  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity.  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues. Assist individuals/legally responsible persons (LRP in choosing service providers; ensuring objectivity in the process. Consistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification.  Utilize person centered planning, motivational interviewing and historical review of assessments to gather information and to identify supports needed for the individual. Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services - and trouble shoots until authorization is obtained.  Notifies providers of successful authorization. Notify providers of successful authorization. For Medicaid C, enlists administrative support to send Level of Care (LOC) and initial Individual Service Plan (ISP) to Department of Social Services (DSS) to turn on special waiver program indicator.  Verify that necessary Client, Employer, Group (CEG) enrollments are correct in Jiva, and that Medicaid eligibility is updated in Alpha. Provide Support and Monitoring to Members Schedules initial contact with member to verify accuracy of demographic information Update inaccurate information from the Global Eligibility File. Completes activities related to Plans of Care  Coordinate and participate with SIS Team to ensure successful completion of SIS assessment within time frames allotted.   For facility (ICF, Hospital, PRTF or SDC) discharges, inform SIS Supervisor that an assessment needs to be scheduled.  Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan. Schedule and facilitate the ISP meeting. Develop and update ISP  Submit requests for services and purchase orders for products, –supplies, and services covered under the Innovations waiver. Coordinate with other team members to ensure smooth transition to appropriate level of care.  Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email.  Complete Home and Community Based Services (HCBS) Notice of Change Form when arranging new HCBS service placement (for Residential Supports, Day Supports, and Supported Employment) with a new provider and submit to Provider Network department to ensure successful transition to provider. Refer provider contractual concerns to Provider Networks. Update other Care Team members of urgent or pertinent treatment updates  Recognize and report critical incidents to supervisors and Quality Management.  Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services.  Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance. Escalate complex cases and cases of concern to Supervisor. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.   Verify ongoing service adherence with member and/or guardian Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care. Complete Documentation  Open new episodes in Jiva and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Distribute surveys to members in service. Ensure that service orders/doctor’s orders are obtained, as applicable.   Obtain releases/documentation and provide to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Ensure clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements. Minimum Education & Experience Bachelor’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area and two (2) years of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI) OR Master’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area and one (1) year of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI), OR Graduation from an accredited Nursing program and licensure as a Registered Nurse Knowledge, Skills, & Abilities Person Centered Thinking/planning Knowledge of using assessments to develop plans of care Knowledge of LOC process, SIS for IDD and FASN assessment for TBI Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefits plans Knowledge of and skilled in the use of Motivational Interviewing Knowledge of and skilled in the use of Motivational Interviewing techniques Strong interpersonal and written/verbal communication skills Conflict management and resolution skills Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.) High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. Ability to make prompt, independent decisions based upon relevant facts Salary $22.15  to $ 38.14/Hourly

We are currently seeking Care Managers to serve members in Cumberland county.     The Care Manager I position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work certain days of the week as approved by their supervisor. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments. Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities.  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity.  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues. Assist individuals/legally responsible persons (LRP in choosing service providers; ensuring objectivity in the process. Consistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification.  Utilize person centered planning, motivational interviewing and historical review of assessments to gather information and to identify supports needed for the individual. Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services - and trouble shoots until authorization is obtained.  Notifies providers of successful authorization. Notify providers of successful authorization. For Medicaid C, enlists administrative support to send Level of Care (LOC) and initial Individual Service Plan (ISP) to Department of Social Services (DSS) to turn on special waiver program indicator.  Verify that necessary Client, Employer, Group (CEG) enrollments are correct in Jiva, and that Medicaid eligibility is updated in Alpha. Provide Support and Monitoring to Members Schedules initial contact with member to verify accuracy of demographic information Update inaccurate information from the Global Eligibility File. Completes activities related to Plans of Care  Coordinate and participate with SIS Team to ensure successful completion of SIS assessment within time frames allotted.   For facility (ICF, Hospital, PRTF or SDC) discharges, inform SIS Supervisor that an assessment needs to be scheduled.  Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan. Schedule and facilitate the ISP meeting. Develop and update ISP  Submit requests for services and purchase orders for products, –supplies, and services covered under the Innovations waiver. Coordinate with other team members to ensure smooth transition to appropriate level of care.  Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email.  Complete Home and Community Based Services (HCBS) Notice of Change Form when arranging new HCBS service placement (for Residential Supports, Day Supports, and Supported Employment) with a new provider and submit to Provider Network department to ensure successful transition to provider. Refer provider contractual concerns to Provider Networks. Update other Care Team members of urgent or pertinent treatment updates  Recognize and report critical incidents to supervisors and Quality Management.  Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services.  Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance. Escalate complex cases and cases of concern to Supervisor. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.   Verify ongoing service adherence with member and/or guardian Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care. Complete Documentation  Open new episodes in Jiva and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Distribute surveys to members in service. Ensure that service orders/doctor’s orders are obtained, as applicable.   Obtain releases/documentation and provide to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Ensure clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements. Minimum Education & Experience Bachelor’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area with (2) years of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI) OR Master’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area and one (1) year of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI), OR Graduation from an accredited Nursing program and licensure as a Registered Nurse Knowledge, Skills, & Abilities Person Centered Thinking/planning Knowledge of using assessments to develop plans of care Knowledge of LOC process, SIS for IDD and FASN assessment for TBI Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefits plans Knowledge of and skilled in the use of Motivational Interviewing Knowledge of and skilled in the use of Motivational Interviewing techniques Strong interpersonal and written/verbal communication skills Conflict management and resolution skills Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.) High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. Ability to make prompt, independent decisions based upon relevant facts Salary $22.15  to $ 38.14/Hourly

We are currently seeking Care Managers to serve members in Durham, Johnston, Cumberland and Wake counties.     The Care Manager I position leads all communication among care team members and is the primary point of contact for the member served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of health services. This position will allow the successful candidates(s) to work a schedule which will include both onsite (in the county served) as well as remote work certain days of the week as approved by their supervisor. Responsibilities & Duties Complete Assessment/Planning Complete comprehensive assessments at enrollment, yearly or at changes in condition. Develop Plans of Care derived from the completed assessments. Assign interventions/plans of care to the Care Worker for monitoring and service engagement activities.  Submit referral to the Integrated Health Consultant when a physical health or behavioral health need indicates medical and/or pharmaceutical complexity.  Assign Plan of Care activities to Community Health Worker if member has identified Social Determinants of Health (SDOH), disparities and/or complex payer issues. Assist individuals/legally responsible persons (LRP in choosing service providers; ensuring objectivity in the process. Consistently evaluate appropriateness of services and ensure implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification.  Utilize person centered planning, motivational interviewing and historical review of assessments to gather information and to identify supports needed for the individual. Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals Submit required documentation to UM to ensure timely delivery of services - and trouble shoots until authorization is obtained.  Notifies providers of successful authorization. Notify providers of successful authorization. For Medicaid C, enlists administrative support to send Level of Care (LOC) and initial Individual Service Plan (ISP) to Department of Social Services (DSS) to turn on special waiver program indicator.  Verify that necessary Client, Employer, Group (CEG) enrollments are correct in Jiva, and that Medicaid eligibility is updated in Alpha. Provide Support and Monitoring to Members Schedules initial contact with member to verify accuracy of demographic information Update inaccurate information from the Global Eligibility File. Completes activities related to Plans of Care  Coordinate and participate with SIS Team to ensure successful completion of SIS assessment within time frames allotted.   For facility (ICF, Hospital, PRTF or SDC) discharges, inform SIS Supervisor that an assessment needs to be scheduled.  Attend Behavior Support Plan (BSP) meetings to ensure successful implementation of the plan. Schedule and facilitate the ISP meeting. Develop and update ISP  Submit requests for services and purchase orders for products, –supplies, and services covered under the Innovations waiver. Coordinate with other team members to ensure smooth transition to appropriate level of care.  Complete check-in/contact with member and/or legally responsible person (LRP) via phone or email.  Complete Home and Community Based Services (HCBS) Notice of Change Form when arranging new HCBS service placement (for Residential Supports, Day Supports, and Supported Employment) with a new provider and submit to Provider Network department to ensure successful transition to provider. Refer provider contractual concerns to Provider Networks. Update other Care Team members of urgent or pertinent treatment updates  Recognize and report critical incidents to supervisors and Quality Management.  Schedule face to face meeting with member/LRP to provide education about Alliance, Care Teams, and services.  Provide education and support, to individuals and LRP, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance. Escalate complex cases and cases of concern to Supervisor. Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.   Verify ongoing service adherence with member and/or guardian Proactively respond to an individual’s planned movement outside the Alliance MCO geographic area to ensure a smooth transition without lapse in care. Complete Documentation  Open new episodes in Jiva and schedule initial contact with member to verify accuracy of demographic information.   Document all applicable member updates and activities per organizational procedure. Distribute surveys to members in service. Ensure that service orders/doctor’s orders are obtained, as applicable.   Obtain releases/documentation and provide to all stakeholders involved.  Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information Ensure clinical documentation (e.g. goals, plans, progress notes, etc.) meets state, agency documentation standards, and Medicaid requirements. Minimum Education & Experience Bachelor’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area with (2) years of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI) OR Master’s degree from an accredited college or university in Health, Psychology, Sociology, Social Work, Nursing or other relevant human services area and one (1) year of experience with Individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injuries (TBI), OR Graduation from an accredited Nursing program and licensure as a Registered Nurse Knowledge, Skills, & Abilities Person Centered Thinking/planning Knowledge of using assessments to develop plans of care Knowledge of LOC process, SIS for IDD and FASN assessment for TBI Knowledge of Medicaid basic, enhanced MHSUD, and waiver benefits plans Knowledge of and skilled in the use of Motivational Interviewing Knowledge of and skilled in the use of Motivational Interviewing techniques Strong interpersonal and written/verbal communication skills Conflict management and resolution skills Proficient in Microsoft Office products (such as Word, Excel, Outlook, etc.) High level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. Ability to make prompt, independent decisions based upon relevant facts Salary $22.15  to $ 38.14/Hourly

MediCapt Toolkit Consultant   Location:   Remote, WorldWide   Classification: This is a temporary, part-time consultancy through November 2021, with the possibility of extension.   Organization Description For more than 30 years, Physicians for Human Rights (PHR) has used science and medicine to document and call attention to mass atrocities and severe human rights violations. We investigate and document abuses, give voice to survivors and witnesses, and plant seeds of reconciliation by ensuring that perpetrators can be held accountable for their crimes. PHR uses our core disciplines – science, medicine, forensics, and public health – to inform our research and investigations and to strengthen the skills of frontline human rights defenders. We work closely with hundreds of partners around the world, using facts to wage effective advocacy and campaigning and providing critical scientific evidence so that survivors can seek justice.   PHR, which shared in the 1997 Nobel Peace Prize for our work to end the scourge of landmines, is poised for even greater growth and impact. As part of that strategy, we are seeking committed activists with a passion for human rights.   Role Description In 2011, Physicians for Human Rights (PHR) launched its Program on Sexual Violence in Conflict Zones to confront impunity for widespread sexual violence – used as both a weapon of war and a common crime. Rare cases that made it to court often failed because of insufficient evidence to support survivors’ allegations. In that context, PHR saw medical professionals as powerful change agents and created an initiative to enhance collaboration between medical and legal professionals to collect, document, and analyze forensic evidence to hold perpetrators accountable, and to improve medical care and access to justice for survivors. PHR has been working with doctors, nurses, trauma counsellors, police officers, lawyers, and judges in Kenya and the Democratic Republic of the Congo (DRC) to develop comprehensive, standardized methods for collecting forensic evidence of sexual violence to increase the likelihood of effective and successful investigations and prosecutions of these crimes.   But health facilities and police stations using paper-based forms often lack proper storage for secure preservation or officials encounter difficulties traveling distances to transmit or retrieve evidence due to poor roads or lack of access to vehicles, among other complicating factors.   To address these challenges and to leverage mobile phone penetration even in the most resource-constrained environments, PHR has been developing a high-tech solution called MediCapt, a mobile application to help clinicians document forensic evidence of sexual violence during a patient encounter. This app converts a standardized medical intake form to a digital platform and combines it with a secure mobile camera to facilitate forensic photography. Clinicians can use the app to compile evidence, photograph survivors’ injuries, and securely transmit the data to police, lawyers, and judges involved in prosecuting these crimes. Digitizing these forms minimizes the chances of loss, tampering, or theft of medical evidence, while preserving chain of custody.   Our partners in the DRC and Kenya see MediCapt as a solution for yielding stronger evidence, preserving chain of custody, and improving data security and privacy. Among its key features, MediCapt includes sophisticated encryption, cloud data storage, high fidelity to chain of custody standards, and tamper-proof metadata. Significantly, the Android-based app is designed to securely collect data in conflict zones, as well as remote locations where internet connectivity and/or wireless data transmission is limited. PHR has been collaborating with clinicians in the DRC and Kenya to improve MediCapt’s features (offline printing, secure photo capture capacity, and back-end review for quality improvement and assurance). We have also been working with health care facilities to integrate the app into clinical workflows and co-developed implementation protocols. We went “live” with patients in Naivasha, Kenya in 2018 and we will soon pilot with patients for the first time in the DRC.   Reports to: Director, Program on Sexual Violence in Conflict Zones   Role Description: MediCapt is an award-winning application developed by PHR that enables clinicians to document medical evidence of sexual violence cases digitally, capture forensic photographs, and store them securely. Clinician end users are currently using MediCapt with sexual violence survivors in Kenya and soon in the Democratic Republic of the Congo (DRC). PHR is developing and implementing a scaling strategy to grow the MediCapt project in partnership with international organizations, humanitarian organizations, and governments. A key piece of the scaling strategy is the MediCapt Toolkit, which is the suite of materials needed to implement the project. The MediCapt Toolkit includes: The MediCapt user manual Training documents (for MediCapt training and forensic photography training) This will include final versions of both PowerPoint slides for these trainings and a Facilitators Guide outlining the training modules M&E tools and plan Troubleshooting documents Institutional policies and procedures Briefs and resources Fact sheets Tech documentation (The documentation of this work will be led by the MediCapt Technical Project Manager and the Tech Advisory Board as a separate but related project) The objective of the MediCapt Toolkit is to have final versions of all materials needed to implement the MediCapt project. As part of the MediCapt scaling strategy, PHR anticipates that other organizations will implement the project and the Toolkit will be the one-stop shop for all MediCapt materials. We will publish the MediCapt Toolkit on the PHR website in November 2021. The MediCapt Toolkit will be published on the PHR website in English and French later this year to accompany the open-source code of the application. We are looking for a consultant to lead the refinement and finalization of the MediCapt Toolkit.   Responsibilities: Serve as lead on the MediCapt Toolkit project. Conduct an assessment of the current materials, identify gaps and areas for improvement, and develop a plan for completing the project. This will also include researching other organizations’ project toolkits to learn and improve on the current materials. PHR has already conducted review of our current materials and a spreadsheet with the status of each document Draft needed materials and liaise with PHR experts to manage development of technical materials. Finalize the MediCapt Toolkit and ensure the materials are ready for publication. Lead meetings with PHR staff and consultants to coordinate the project and participate in regular calls with the PHR team. Complete four key deliverables:     Deliverable Estimated days Landscape assessment of current materials 7 Work plan for project (and revisions of plan if needed from PHR input) 2 Draft MediCapt Toolkit 12 Final MediCapt Toolkit, including feedback from PHR team 8                       Qualifications and Skills Experience in  developing tools, materials, programming, education, or research to address sexual and gender-based violence; Ability to adjust and create tools; Pro-activity and ability to work independently Excellent project manager, flexible and skilled in executing multiple tasks, managing work plans and budgets, and working with diverse groups of stakeholders across multiple global teams; Superb oral and written communication skills in English; Experience working on tech-related global health, justice, or  human rights projects Excellent cross-cultural communication skills; Ability to produce clear written products in English with minimal editing, French-language skill a plus. More information about Physicians for Human Rights can be found at www.phr.org.   To Apply Please combine your cover letter and resume as a pdf or Word doc and send it to resumes@phr.org . Indicate your “ Last Name/First Name, MediCapt Toolkit Consultant ” in the email subject line.   A complete application consists of: a) A thoughtful cover letter explaining why you are qualified for/interested in the MediCapt Toolkit Consultant position with PHR.  b) Resume/Curriculum Vitae.   Only complete applications in the format requested and sent to resumes@phr.org will be considered.   Physicians for Human Rights is an equal opportunity employer committed to inclusive hiring and dedicated to diversity in its work and staff. We recruit and hire without discrimination based on race, national origin, religion, gender, gender identity, sexual orientation, prior conviction, arrest history, disability, marital status, veteran status, age, or any other protection afforded by law.