Description & Requirements
The Case Manager provides comprehensive coordination of services for service members and their families. This role coordinates patient care and documentation pathways and serves as a liaison between military and civilian medical and non-medical agencies to support continuity of care. The RN Case Manager conducts assessments, planning, and evaluation of care to promote optimal health and support successful transitions back to duty or into the civilian community.
Candidates must live in or near Camp Pendleton, CA; Coronado, CA; Cannon AFB, NM; Dam Neck, VA; JEB Little Creek, VA; Fort Benning, GA; Fort Bragg, NC; Fort Campbell, KY; Fort Carson, CO; Joint Base Lewis-McChord, WA; Homestead AFB, FL; Hurlburt Field, FL; Eglin AFB, FL; or MacDill AFB, FL.
U.S. citizenship is required. Candidates must possess an active U.S. Government Secret security clearance or be eligible to obtain and maintain a Secret security clearance as required for contract performance. This position is pending upon contract award.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as expert in field within the organization.
- Active RN license OR Active Licensed Clinical Social Worker (LCSW) license with a minimum two (2) year nursing degree from an accredited institution.
- Minimum of (2) years of nursing and/or case management experience.
- Certification as a case manager by a recognized certifying organization, such as the Commission for Case Manager Certification, American Case Management Association, or American Nurses Credentialing Center; or ability to obtain certification within one (1) year of hire.
- Professional oral and written communication skills with peers, outside agencies, vendors, providers, and Military Health System stakeholders.
- Skill in team coordination, facilitation, and communication to support information exchange, goal achievement, client support networks, and change in systems or policies.
Home Office Requirements
-Maximus provides company-issued computer equipment
-Reliable high-speed internet service
-Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Salary
$
73,950.00
Maximum Salary
$
105,850.00
