Case Manager in Franklin, TN at Maximus

Date Posted: 11/18/2020

Job Snapshot

Job Description

_This job requires a Bachelor's degree and 2+ years of professional experience working with persons with serious mental illness and/or intellectual disability.
_Perform document-based and telephonic utilization review for contracted services; screening for diagnosis or suspicion of serious mental illness and or intellectual disability, and medical necessity for short or long term nursing facility placement.


 

Essential Duties and Responsibilities:

- Make outbound phone calls to nursing facilities to determine eligibility for pre-admission, concurrent reviews for admissions, continued placement in Medicaid certified nursing facilities, utilizing federal and State’s criteria

- Schedule document-based quality reviews that adhere to state-directed clinical criteria for determining medical need

- Reviews and communicates all information with providers, utilizing computer database system for determining nursing facility placement appropriateness.  Utilizes both referral screens and medical records review to make determinations

- Responsible for pulling data from multiple systems, performing data analysis, and then initiating robotic process automation jobs to move data between systems

- Review rejected data and troubleshoot the cause, and correct any source files to prevent future occurrences of rejects

- Perform data analysis functions to ensure integrity of data in systems used by the program. Some intermediate to advanced excel based skills is necessary to reconcile data between systems

- Monitor multiple work queues daily to ensure cases move quickly through each process stage. If data errors or human errors are preventing the case from moving forward, determine and resolve the problem

- Assist with monthly billing and quarterly reporting processes which includes extracting data from two systems, performing analysis to consolidate data found in both systems, and perform manual research when data has not been properly entered

- Provide feedback to Program Manager of the types of errors and root causes

- Review submitted evaluations for potential duplicates. Make outbound calls to facilities to determine cause

- Track high volume and/or difficult to reach facilities. Pull queries to identify which facilities have caused the turn-around-time contractual standard to be missed, so data can be reported to the State

- Complete other job duties as assigned or necessary

Minimum Requirements:

- High School diploma or equivalent with 4+ years of professional experience working with persons with serious mental illness and/or intellectual disability, or AA degree with 2+ years of professional experience working with persons with serious mental illness and/or intellectual disability

- Bachelor’s degree in human services related field preferred

- Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures

- Excellent knowledge of diverse cultures and issues, with the ability to incorporate special needs into utilization review decisions

- Working knowledge and understanding of behavioral health diagnoses, psychotropic medications, medical diagnoses and prescribed medications

- Excellent ability to multitask while effectively performing job duties, which include prioritizing tasks;  ensure all voice mail and email messages are monitored and responded to within 2 hours of receipt

- Ability to work independently, as well as within a team while exhibiting excellent interpersonal skills

- Excellent written and verbal communication skills

- Ability to interact professionally with providers (hospital & nursing home staff, physicians, community service workers, etc.), state contract officers, and coworkers while seeking or providing information

- Ability to collect data, define problems, establish facts, and draw valid conclusions for supporting a superior written rationale for review determination

- Excellent computer skills with experience in word processing, email and spreadsheets (Microsoft Word, Outlook preferred and intermediate (to advanced) Excel skills  required); ability to work with dual computer monitors, research information on the internet, utilize company resources/ tools stored on company sites


MAXIMUS Introduction
Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.
 
EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.