Job: Case Manager

Job Description

Job Type: Hourly

Wage: $17.50-$22.43/hr.

Location: Canon City, CO.

Job Description:

Valley-Wide Health Systems, Inc. (Valley-Wide) welcomes and is committed to all patients and populations within our large multi-county service area throughout southern Colorado. As a non-profit, Federally Qualified Health Center (FQHC), we provide premier primary and preventive care you can trust at our 34 service sites strategically located throughout multiple rural counties. Our mission is to provide safe and effective personalized treatments for all, with a particular focus on medically underserved populations.

 We are looking for a Case Manager to provide pro-active support to care teams, patients and staff. The case manager will provide patient navigation by connecting patients with services that appropriately meet their needs, by reducing barriers to health care, and effectively directing patients to services that can help further optimize their health status. Foster a culture of patient and family centered care, service, quality, and safety excellence; while improving patient experience, employee experience and community relations.

Job Qualifications:

• Complete a comprehensive assessment of referred patients by exploring clinical needs, psychosocial needs and social determinants of health to assist in effective health maintenance, adjustment, and improvement of patient.
• Participate in a medical home model of care using a team-based approach, including helping patients identify a Primary Care Provider, participate in Team Huddles, and develop and evaluate progress with individual health care plans and goal-setting.
• Facilitate patients and families through adjustment processes including understanding medical/dental recommendations, decision-making regarding care management and options for care
• Provide Health Navigation and Assistance with Medical Referral Services and Specialty Dental Services
  • Complete pre-authorization in accordance to patient’s payer source requirements.
  • Schedule Imaging and Diagnostics with Performing Entity
  • Keep patient informed and provide timely response to patients on the status of obtaining prior authorization from insurance companies.
  • Monitor and track all pre-authorizations submitted, approved, and pending, follow up as needed and document progress.
  • Follow up on any denied authorization requests, determine the reason for denial and if additional information is required for re-submission and facilitate an appeal if appropriate
• Facilitate and coordinate patient care by reviewing and monitoring treatment plans and appropriate documentation to assist patient in understanding. Contact insurance companies to verify coverage and extent of benefits
• Enroll qualified applicants in the Senior Dental Program and assist them with enrollment. Collect and maintain required records
• Displays enthusiasm toward the work and the mission of the organization
• Core philosophy or values consistent with a family-centered approach to care
• Demonstrate a sensitivity and responsiveness to varying cultural characteristics and beliefs and have a spirit of kindness and concern
• Provide Health Navigation and Assistance with Referral Services
  • Assist in navigating any potential barriers to expediting referrals for medical, ancillary, and community based services for patients and their families
  • Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance)
• Complete a comprehensive assessment of referred patients by exploring clinical needs, psychosocial needs and social determinants of health to assist in effective health maintenance, adjustment, and improvement of patient.
• Maintain professionalism and positive attitude
• Other duties as required

Benefits:

• Health, Dental, Vision Insurance, HRA, FSA, DCA Retirement Plan
• MASA – Employer paid Air Ambulance Coverage
• Employer paid Basic Life, LTD, STD
• Retirement Match
• Paid Leave:
  • Vacation – 10 days accrued/year
  • Sick – 12 days accrued/year
  • Holidays – 8 days/year + 2 Floating 
  • Bereavement and Jury Duty
  • Extra " PTO" Opportunities
• FREE Health Insurance (Other healthcare coverage plan options available)
• Local Gym Discounts
• Free Employee Assistance Program
• Cell phone discounts (Limited to Verizon Wireless)

Education and Requirements:

• High School Diploma required.
• Bachelors in Business/Healthcare Administration, human services, social work or related field preferred OR one (1) year of qualifying experience.
• Bilingual (English/Spanish) preferred but not required
• Ability to successfully pass a drug test and background screen

Visit our website at https://valley-widehealth.org/careers/ for more information.

Valley-Wide Health Systems, Inc. is an Equal Opportunity Employer: We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

**Disclaimer: The duties and responsibilities described above are not a comprehensive list and additional tasks may be assigned to the employee, time to time; the scope of the job may change as necessitated by business demands. Click “View Application” below for more detail on this specific job.