Primary City/State:Arizona, ArizonaDepartment Name:ALTCS CMWork Shift:DayJob Category:Clinical CareYou have a place in the health care industry. If you’re looking to leverage your abilities to make a real difference – and real change in the health care industry – you belong at Banner Plans & Networks.Banner Plans & Networks (BPN) is an integrated network for Medicare and private health plans. Known nationally as an innovative leader, BPN insurance plans and physicians work collaboratively to keep members in optimal health while reducing costs. Supporting our members and vast network of providers is a team of professionals known for innovation, collaboration, and teamwork. If you would like to contribute to this leading-edge work, we invite you to bring your experience and skills to BPN.As an Arizona Long Term Care (ALTCS) Case Manager, you will be required to visit members in their current living environments, which may include assisted living facilities, nursing homes, or their own homes. You will conduct assessments on a 90-day or 180-day schedule for each member assigned to you. Your responsibilities include assessing the needs of members and arranging services to meet those needs. Additionally, you will assist with hospital discharge planning and placements. In your Remote Hybrid role based in Yuma County, Arizona, you will visit members' homes and/or facilities within the community several times a week. Please note this role does require Yuma County, Arizona residency for territory and compliance. This role will also require travel to La Paz County, Arizona 1-3 times per month. If this role sounds like the one for you, apply today!The primary work schedule is Monday through Friday during business hours in the Arizona Time Zone. Additionally, there is a limited call schedule, details of which will be provided during the interview process.Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.POSITION SUMMARYThis position is responsible for assessing, documenting and monitoring the overall functional, physical and behavioral health status of members assigned to them. Based on the assessments, the case manager, collaborating with the member and his/her support system, develops a service plan that meets member needs in the most cost-effective and most integrated setting.CORE FUNCTIONS
Is the primary contact for the ALTCS member, explaining the program to members, including their rights and responsibilities, the grievance and appeal system and other information according to regulations.
Comprehensively assesses and documents the member’s bio psychosocial functioning in accordance with AHCCCS time frames, identifying the individual’s strengths and needs.
Develop and implements a service plan based on the member’s strengths, needs and placement preferences, authorizes and coordinates with provider agencies.
Assists the member to define personal goals, identifying barriers to achieving these goals and encouraging the member to resolve the difficulties identified.
Acts as a facilitator and/or advocate for the member in dealing with issues with providers, community programs or other organizations.
Acts as a gatekeeper to ensure that the member is receiving the most appropriate, cost-effective services in the most appropriate setting.
Facility based while remaining within budgetary allowances. Internal customers: all levels of nursing management and staff, medical staff, and all other members of the interdisciplinary healthcare team. External customers: physicians, payers, community agencies, provider networks and regulatory agencies.
MINIMUM QUALIFICATIONSKnowledge, skills and abilities as normally obtained through the completion of a bachelor’s degree in social work, and two years of experience serving persons who are elderly and/or persons with physical disabilities or who are determined to have a Serious Mental Illness (SMI).PREFERRED QUALIFICATIONSBilingual, preferred in some assignments.Additional related education and/or experience preferred.EEO Statement:EEO/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo)Our organization supports a drug-free work environment.Privacy Policy:Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)EOE/Female/Minority/Disability/VeteransBanner Health supports a drug-free work environment.Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability