At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA - the National Committee for Quality Assurance - for our Ohio HMO, Elite and Advantage products. We're also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest.
Our mission is to improve your health and well-being. So we're committed to your wellness with various initiatives, such as preventive services, online knowledge, health risk assessments, our Steps2Health disease management programs, health fairs, and more.
TheAdvantage Substance Use Disorder Case Managerassesses, plans, implements, coordinates, monitors and evaluates the ongoing care of a specific caseload of members diagnosed with Substance Use Disorders, through the Continuum of Care; collaborates with members of the health care team, members and their families to ensure effective, efficient and appropriate care during the entire episode of illness and for post-discharge services. Monitors utilization and evaluates outcomes. No positions report to this position.Position Summary
- Assessment: Assess identified "Advantage" members to determine case management needs by trigger diagnoses, disease management needs, high dollar cost, complex substance use disorder conditions, emergency room utilization, readmissions or excessive length of stay. Conduct a comprehensive health care plan review that includes member contact and provider contact. Assess the member's functional status, decision-making ability, and psycho-social needs. Enter identified "Advantage" members into Advantage Case Management Program with provider and member consultation and member consent.
- Planning: Plan a flexible care plan developed in conjunction with the member, provider, health care team and other persons involved in the member's care. The plan should address the member's health care needs identified in the assessment process. Community resources, psycho-social needs and end of life care are included in the plan of care.
- Implementation and Coordination: Coordinate current treatment plans with the primary provider and maximize benefits through in-Plan provider utilization. Utilize cost benefit analysis. Ensure communication of goals with all health care team members. Coordinate physical health care with in-Plan providers and with Medical Case Management coordinators.
- Monitoring and Evaluation: Review the member's progress and conduct periodic reassessment of the care plan based on changing member needs. Evaluate, initiate and coordinate case management members' potential discharge planning and follow-up needs. Evaluate and manage resources and optimize reimbursement to ensure that members receive the most appropriate medical care in the most cost-effective setting.
- Communication: Provide members and families with ongoing, current information and support to enhance satisfaction throughout the continuum of care. Facilitate communication among members of the health care team. Ensure privacy and confidentiality under current federal regulations. Adherence to ethical, legal and accreditation/regulatory standards
- Documentation: Documentation follows current Paramount procedures. Has good knowledge of Advantage/Medicaid coverage, exclusions and Medicaid guidelines for appropriate system documentation. Demonstrates good skills in the required paper and electronic systems.
- General: Act as a member advocate, maintain and ensure member privacy and confidentiality, adhere to ethical, legal and accreditation/regulatory standards for all Case Management activities/interventions. Case management interaction is telephonic throughout the case management process as defined above. In addition, multidisciplinary face to face meetings with members and providers are necessary to effectively coordinate the member's treatment plan of care. Must have the ability to travel and make in-person visits with members.
ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 49,000 employees, 12 hospitals, 2,500+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and 330+ assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, and hospice and home health care agencies. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. For more information about ProMedica, please visitwww.promedica.org/aboutus.
- Current Ohio and Michigan Registered Nurse license required or current Ohio and Michigan license for LSW, LISW, LPC, PhD and/or other equivalent and appropriate licensure.
- CDCA (Chemical Dependency Counselor Assistant)strongly preferred
- Valid driver's license with proof of auto insurance
- Must have the ability to travel and make in person visits with members. Visits may take place in a variety of settings; including but not limited to member home/provider office.
- Certification in Case Management strongly preferred. If not certified, willingness to obtain certification when eligible and appropriate as deemed by manager.
- Minimum 2 years experience working with people with substance use disorder conditions as a Case Manager or Utilization Management Coordinator. Excellent communication (oral and written) and organizational skills required. Demonstrated ability to plan, coordinate and organize multiple priorities.
- Demonstrated PC skills, including word processing/spreadsheet/data base and graphics applications strongly preferred. Experience with electronic health record documentation.
- Ability to move between company work stations and departments; ability to communicate on telephones and operate general office equipment, including computers.
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.
Equal Opportunity Employer/Drug-Free Workplace
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