You strive to create change for the better. You believe access to quality, affordable health care is important. You work hard to inspire other team members. If this sounds like you, we hope you’ll share your talents with us. Here at Colorado Access, we’re working to partner with communities and empower people through access to quality, affordable care. And to do so takes talented employees.
This position is for a physical health clinical CMII, which requires a physical health clinical degree (BSN/RN, DC, PT, OT) and clinical experience.
Under the supervision of the Manager of Care Management, the Care Manager II is responsible for completing the appropriate level of care management activities for Colorado Access members. Specifically, this position will provide complex care coordination and case management for high acuity members and requires complex clinical decision making. Care management activities will include but will not be limited to completing assessments, determining eligibility, monitoring provider services, coordinating services, developing care plans, delivering care management interventions, appropriate follow up activities and completing all documentation in the expected time frame. The Care Manager II will apply appropriate criteria, guidelines, and regulations specific to the level of care and services required to meet the member/family goals and the organizational/contractual requirements. Care management functions may be performed for members in a variety of settings including telephonic, in-person or in the community setting.
ESSENTIAL FUNCTIONS & WORK DUTIES
The following essential functions of this position are performed personally, in cooperation with your supervisor, and/or in coordination with other staff. Additional work functions and duties may be assigned.
Assesses and identifies member strengths, needs, concerns, and preferences through interviewing, observing, and administering structured instruments, to collect data about the member’s health, function, behavior, mental health, cognition, environment, finances, and support system.
Performs advanced clinical assessments and provides clinical knowledge of emotional disorders, chronic health, medication issues, substance use disorders, communicable diseases, and advanced directives.
Establishes goals and care plans with members and their natural supports if applicable.
Implements care plans through coordinating services and interventions by referring, educating, negotiating, and mediating with members and formal or informal providers.
Manages and monitors the ongoing provision of and need for care by monitoring the delivery and quality of services and interventions provided. Performs ongoing monitoring of member status and satisfaction with services and makes adjustments to care plans as needed.
Assists in identification of risk factors leading to increased utilization and works to reduce preventable hospitalizations, readmissions, and inappropriate utilization.
Communicates with members utilizing person centered thinking and language through all aspects of care management.
Establishes professional and effective collaboration, communication, and coordination among all responsible parties of an individual member’s interdisciplinary health care team.
Actively participates in clinical presentations and or/ interdisciplinary team meetings, disposition planning, department meetings, and organizational meetings and communicates progress and barriers with Supervisor/Manager.
Maintains knowledge and educates members regarding various state plan benefits, programs, options and services.
Responsible for accurate and timely completion of all forms, reports, and documentation of care management activities.
Maintains professional and ethical manner with all interactions and meets performance, quality, customer service, and coordination standards as assigned by the department management team.
Assists members and providers in understanding the complaint, grievance and appeal process.
Participates in training and staff development opportunities. Actively participates in team meetings and communicates progress and barriers with Coordinator Supervisor and/or Department Manager.
Manage projects with staff at all levels Novice
Strong analytic skills w/ data Intermediate
Proficient in Word, Excel, SharePnt, PowerPnt Intermediate
Knowledge of local health agencies Some Knowledge
Team Player: Works well as a member of a group
Functional Expert: Considered a thought leader on a subject
Enthusiastic: Shows intense and eager enjoyment and interest
Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Dedicated: Devoted to a task or purpose with loyalty or integrity
Job Security: Inspired to perform well by the knowledge that your job is safe
Self-Starter: Inspired to perform without outside help
Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work
Flexibility: Inspired to perform well when granted the ability to set your own schedule and goals
Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
Bachelors or better in Nursing or related field. Masters or better in Degree Preferred.
Three years of clinical, care management and/or healthcare experience required. Experience working with Medicare and Medicaid populations, and related social/economic issues delivering care management services, conducting assessments, interviewing members, developing service plans, coordinating care and monitoring services for members preferred.
Licenses & Certifications Required
Preferred: Registered Nurse
We offer a robust benefit and compensation package and lots of opportunities for you to grow.
Our benefits include:
Paid time off (PTO)
Medical, dental and vision insurance
A 401(k) with matching
Additionally, we offer a progressive company culture that embraces diversity and provides a friendly environment. We are committed to making Colorado Access a fun, rewarding place to work.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.
Meet Colorado Access recruiters at the CHA Health Care Job Fair May 1st. Sign up here and save time at the do
Internal Number: CAREM01558
About Colorado Access
Colorado Access is a local, nonprofit health plan that serves more than one million members. The company’s members receive health care under Child Health Plan Plus (CHP+), and Health First Colorado (Colorado’s Medicaid Program) behavioral health, physical health, and long-term support programs. Colorado Access provides care coordination services and administers behavioral health and physical health benefits for two regions as part of the Regional Accountable Entity program through Health First Colorado. Colorado Access is the state’s largest single entry point agency, coordinating long-term services and supports for more than 10,000 Health First Colorado recipients.