Under the general supervision of the Director, or designee, the Retirement System Case Manager is responsible for providing administrative case management as part of state retirement systems disability benefit programs. This position is responsible for assessing, case management planning, organizing, reviewing and evaluating the care needs of Participants who have been determined disabled from their current state-held positions. This position fosters and promotes continuity of care and facilitates the return to employment, where possible, by working closely with Participants to ensure compliance with their treatment plans, providing clinical education and resources and providing ongoing coaching and feedback.
Serve as the case manager for an assigned caseload of Participants who have been determined disabled from their current state-held positions.Provides case management to assess, plan, organize, review and evaluate the care needs of Participants requiring health care services, to include outpatient and home-based therapy services.Conduct telephonic reviews and assessments of Participants' clinical and vocational needs in accordance with program guidelines and regulations.Demonstrates an ability to use critical thinking skills to identify when to conduct additional outreach or review on assigned cases and when to escalate to assigned supervisor.Prepare and implement Participant Case Management Plans.Complete scheduled appointments within designated timeframes.Adheres to contract requirements, individual productivity measures and key performance indicators.Review and document all relevant information into data system applications in accordance with program guidelines and regulations.Conduct routine and ad-hoc evaluations and re-evaluations of Participants needs.Provide appropriate clinical resources and clinical education as appropriate.Contact and engage providers, state agency offices, and Participants to obtain information and records needed to conduct a comprehensive clinical review of the case..Evaluate and document the appropriateness of Participants' services and recommend modifications, as appropriate.Maintain individual records documenting all Participant encounters and contacts; write clinical summaries.Foster and promote continuity of care and cooperative partnerships by liaising with health care providers, involved in the provision of services.Maintain positive working relationships with Participants, relevant informal supports, provider organizations, and state agencies.Maintain the confidentiality of all business documents and correspondence per UMMS/CWM procedures and HIPAA regulations.Participate in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.Comply with established departmental policies, procedures and objectives.Perform other duties as required.
REQUIRED EDUCATIONBachelors Degree in Nursing or a Masters Degree in Social Work, Vocational Rehabilitation CounselingREQUIRED WORK EXPERIENCE5-7 years of work experience with at least 3 recent years providing direct service or case management to individuals with disabilities or disabled workersAbility to work independently in a remote environmentExperience with Office Application and databasePREFERRED WORK EXPERIENCEExperienceCase Management Certification Knowledge of applicable state regulations