Case Manager

SUMMARY

Individuals in this position are expected to function as highly educated, compassionate Case Managers who regularly exercise their professional training and discretion to assist our participants with their everyday needs, which include, but are not limited to, person-centered planning and services. This may include assisting participants affected by issues such as neglect, domestic violence, or mental health issues. Cases will be handled by phone or in person. You will oversee the process of assessing participants, gathering relevant information about their cases, providing risk management counseling, and contacting and referring them to appropriate providers for the further development and implementation of a person-centered plan. A key to succeeding in this role is the ability to stay calm, empathize with, console, and otherwise effectively interact with participants who are often upset, agitated, and/or under tremendous stress.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

1. Maintaining current documentation of the participant’s eligibility for waiver services, copies of the participant’s individual service plan, and individual budget, financial data and related information, managing participant records, ISPs, meeting with participants, documenting via service notes.
2. Collaborate with participants, caregivers, physicians and other providers to develop and determine a comprehensive Person-Centered Plan.
3. Conduct timely intake and assessments for new participants as well as yearly reviews for existing participants.
4. Knowing each participant on a personal basis and being aware of each participant’s particular needs, strengths and weaknesses, and each participant’s general ability to analyze, interpret and make decisions from varying facts and/or circumstances to achieve their desired lifestyle.
5. When assessing and monitoring the health and welfare of the participant it is the Case Manager’s responsibility to ensure the quality of services provided to the participant through routine face to face visits, routine telephone calls or as required.
6. Connecting the participant to all needed medical services regardless of the source of payment.
7. Assist participants to identify the appropriate qualified vendors for their assessed need. Facilitate the completion of the identified vendor project ensuring participant satisfaction. Documenting as required.
8. Adheres to Agency code of ethics and complies with the Federal, State and Agency Mandated Regulations/guidelines/standards applicable to the HCBS Waivers including reporting requirements and general standards of the waivers.
9. Function as a liaison to external agencies and share authorized information with others, that impacts care and/or services of participants.
10. Effectively report person centered plans and other participant related activities both verbally and in writing to authorized sources.
11. Coordinate preventative opportunities/measures to promote early identification and interventions for at-risk participants to ensure health and safety as a mandated reporter.
12. Getting participants involved in beneficial activities; i.e employment, volunteering, community integration, etc.
13. Participate in the marketing of the agency.
14. Identify, report, and address quality issues through observation and data sources.
15. The employee must be able to efficiently navigate changes in policy and procedure.
16. Assists with quality activities as assigned by the supervisor.
17. Participate in required training, supervision, and meetings, and meet state requirements of 40 hours of training the first year and 20 hours annually thereafter. Required training includes:
    1. Prior to providing a service to a participant, a staff member shall be trained on how to provide the service in accordance with the participant’s service plan.
    2. Staff member attendance at training.
    3. Prevention of abuse and exploitation of participants.
    4. Reporting critical incidents/Mandated Reporter
    5. Participant complaint resolution.
    6. Department-issued policies and procedures.
    7. Provider’s quality management plan.
    8. Fraud waste and abuse detection and prevention
    9. Communication and cultural diversity
    10. Documentation
    11. Deescalation

Additional Responsibilities:

1. Responsible for providing field and remote instruction for professional peers in various disciplines as opportunities permit.
2. Perform additional related duties as assigned by the Supervisor.
3. Occasional overnight travel for training/seminars.
4. Extensive travel within a regional area.

Knowledge, Skills, and Abilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Advanced knowledge acquired by a prolonged course of specialized intellectual instruction and requiring consistent exercise of discretion and judgment is essential. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Experience in working with or providing services for individuals with disabilities and/or special needs, as well as skills in diagnosis, assessment and a commitment to the participant control philosophy.
2. Ability to work as part of a comprehensive service and health orientated team.
3. Familiarity with community support systems, health care and human service resources, court and police activities, etc.
4. Represent the agency in a professional manner.
5. Good organizational skills and administrative abilities.
6. Ability to successfully operate a personal computer and sustain a working knowledge of required software.
7. Ability to adhere to the professional code of ethics.
8. Apply knowledge and skills to assess, analyze and determine the needs of the participants.
9. Knowledge of and ability to comply with the Federal, State and Agency Mandated Regulations/Guidelines/standards applicable to HCBS Waivers and Autism waivers.

Qualifications:

1. Bachelor’s degree including or supplemented by at least 12 college-level credit hours in sociology, social welfare, psychology, gerontology, or another behavioral science. Plus, all required training is mandated by the applicable State and Federal agencies.

or

1. One (1) year of experience in working with individuals with traumatic brain injury (TBI) preferred.
   1. Experience includes:
      1. Coordinating assigned services as part of an individual’s treatment plans.
      2. Teaching individuals living skills.
      3. Aiding in therapeutic activities.
      4. Providing socialization opportunities for individuals.
   2. Experience does not include:
      1. Providing hands-on personal care for people with disabilities or individuals over 60 years of age.
      2. Maintenance of the individual’s home, room or environment.
      3. Aiding in adapting the physical facilities of the individual’s home.
2. Possession of a valid driver’s license and access to a private vehicle for day-to-day job performance due to making home visits requiring frequent local and occasional state-wide travel. The Agency also requires a Motor Vehicle Record Check.
3. In accordance with Federal and the state of West Virginia regulations governing facilities/agencies that offer care-dependent services, a facility/agency may not hire an applicant nor retain an employee required to submit a criminal history report if the criminal history report reveals a felony conviction under The Controlled Substance, Drug, Device and Cosmetic Act or a conviction under any of the West Virginia Crime Codes. In addition, any felony offense under Chapter 39, of the Crime Code (relating to theft & related offenses), or two or more misdemeanors under Chapter 39 will prohibit the hiring of the applicant or retaining the employee. Agency requires a Criminal Background Check as well as a Child Abuse History Clearance.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job:

1. The employee must be able to make judgement decisions and communicate clearly
2. The employee if frequently required to walk and sit
3. The employee occasionally is required to stand and reach with hands and arms

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job:

1. The employee is frequently exposed to wet and/or humid conditions and frequently exposed to outside weather conditions including poor driving conditions.
2. The noise level in the work environment is usually minimal to moderate

Note: These statements are intended to describe the general nature and level of work involved for this job. It is not an exhaustive list of all responsibilities, duties, and skills required of this job.