Job Description

Department Name:

ALTCS CM

Work Shift:

Day

Job Category:

Clinical Care

Estimated Pay Range:

$26.40 - $44.00 / hour, based on location, education, & experience.

In accordance with State Pay Transparency Rules.

• Travel is required for the role, must be located in Graham County or Greenlee County.

Recognized nationally as an innovative leader in health care, Banner Plans & Networks (BPN) integrates Medicare and private health plans to reduce healthcare costs while keeping our members in optimal health. Known for our innovative, collaborative, and team-oriented approach, BPN offers a variety of career opportunities and innovative employment options by offering remote and hybrid work settings.

We are part of the insurance division with Banner Health. We service the Arizona long term care AHCCCS population. We case manage beneficiaries to ensure services are identified and authorized according to member’s person-centered assessments.

The Case managers evaluate members and determine what type of services are required and authorize services. Our populations include members in the nursing home, assisted living, behavioral health settings and in member’s home. Case managers day include phone calls, data entry, setting appointments for pre assessment call and assessments. Case managers travel to member’s home. Assist with schedule medical appointments and transportation. Filing grievance from members. Collaborate with department nurses and behavioral health coordinators. Will attend community functions.

8am to 5pm Monday - Friday

• Travel is required for the role, must be located in Graham County or Greenlee County.

Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

Position Summary

This position is responsible for assessing, documenting and monitoring the overall functional, physical and behavioral health status of members assigned to them. Based on the assessments, the case manager, collaborating with the member and his/her support system, develops a service plan that meets member needs in the most cost-effective and most integrated setting.

Core Functions

• Is the primary contact for the ALTCS member, explaining the program to members, including their rights and responsibilities, the grievance and appeal system and other information according to regulations.
• Comprehensively assesses and documents the member’s bio psychosocial functioning in accordance with AHCCCS time frames, identifying the individual’s strengths and needs.
• Develop and implements a service plan based on the member’s strengths, needs and placement preferences, authorizes and coordinates with provider agencies.
• Assists the member to define personal goals, identifying barriers to achieving these goals and encouraging the member to resolve the difficulties identified.
• Acts as a facilitator and/or advocate for the member in dealing with issues with providers, community programs or other organizations.
• Acts as a gatekeeper to ensure that the member is receiving the most appropriate, cost-effective services in the most appropriate setting.
• Facility based while remaining within budgetary allowances. Internal customers: all levels of nursing management and staff, medical staff, and all other members of the interdisciplinary healthcare team. External customers: physicians, payers, community agencies, provider networks and regulatory agencies.

Minimum Qualifications

Knowledge, skills and abilities as normally obtained through the completion of a bachelor’s degree in social work, and two years of experience serving persons who are elderly and/or persons with physical disabilities or who are determined to have a Serious Mental Illness (SMI).

Preferred Qualifications

Bilingual, preferred in some assignments.

Additional Related Education And/or Experience Preferred.

EEO Statement:

Our organization supports a drug-free work environment.

Privacy Policy:

Job Tags

Similar Jobs