Echo Case Manager

Title Echo Case Manager

Duration 6 months Temp to Hire

Shift Standard Mon to Fri

Location Remote

(Case Manager serious diagnoses. Children/Pediatric with down syndrome serious disabilities physical disabilities.)

Job Summary:

• The position provides case management services for TRICARE beneficiaries registered in the Extended Care Health Option (ECHO) under TRICARE. The ECHO is a supplemental program to the TRICARE Basic Program and includes services and supplies to eligible ActiveDuty Family Members (ADFMs) with serious intellectual or physical disability. These benefits are an additional financial resource beyond what is available under the beneficiarys basic TRICARE plan offering an integrated set of services and supplies designed to assist in the reduction of the disabling effects of the beneficiarys qualifying condition.

Key Responsibilities:

• Providing case management services to TRICARE beneficiaries who qualify for the ECHO and ensuring access to equipment or other services as clinically appropriate and according to TRICARE policy.
• Conducts clinical review for requested services particular to the ECHO according to policy collaborating with Medical Directors as needed.
• ECHO Case Managers serve as subject matter experts regarding the ECHO benefit as well as having command of the TRICARE basic benefit structure.
• Applies knowledge of HIPAA privacy and security regulations as well as URAC accreditation standards to ensure compliance in daily practice.
• Completes comprehensive case management assessments and develops individualized case management care plans to assist beneficiaries with obtaining access to quality care in a costeffective manner.
• Coordinates with the Primary Care Manager (PCM) or specialty health providers for information and input into the individualized care plan and makes that plan available to all interested parties.
• Reassesses and monitors care plans for adjustments monthly at a minimum to address newly identified needs services treatment and funding options.
• Documents activity and implements changes in the care plan maintained in the medical management system.
• Evaluates case management outcomes assessing the individual beneficiarys satisfaction and compliance with the care plan.
• Prepares and presents cases involving highprofile or sensitive issues to the Medical Director for review.
• Functions as an advocate for the beneficiary by ensuring access to necessary care and maintaining the beneficiarys safety locating specialized services outside the network by identifying providers exploring the nature of services offered and pricing or service delivery options.
• Supports beneficiaries by providing TRICARE and community resource information and internal care referrals as needed to meet care plan goals.
• Screens for high risk factors indicating appropriateness for complex case management services from a nonECHO case manager.
• Maintains knowledge of and compliance with URAC Foundational Standards and department norms.
• Monitors and provides direction to nonclinical staff.
• Regular and reliable attendance is required.
• Other duties as assigned and applicable

Education & Experience:

Required:

• Current unrestricted licensure in an appropriate state or territory of the United States as a Licensed Clinical Social Worker or Registered Nurse
• U.S. Citizenship
• Must be able to receive a favorable Interim and judged final Department of Defense (DoD) background investigation.
• Three years fulltime equivalent of direct clinical care to the consumer
• Ability to obtain a URACrecognized certification in case management within four (4) years of hire.

Preferred:

• 2 years experience working with populations with serious intellectual or physical disabilities.
• 2 years case management experience
• URACrecognized case manager certification

Competencies

• Communication / People Skills: Capacity to effectively influence and persuade individuals in diverse situations adapt communication styles to varying contexts actively listen critically analyze information and foster collaboration.
• Computer Literacy: Proficiency in navigating and utilizing various Microsoft applications including word and Outlook as well as departmental specific software and internetbased tools within a multisystem environment.
• Coping / Flexibility: Capable of navigating through diverse situations and interacting effectively with individuals while maintaining a sense of purpose and employing mature critical thinking skills demonstrating adaptability and resilience.
• Empathy / Customer Service: Customer centric approach that ensures patience respect attentive listening and empathy toward the perspective of the customer.
• Independent Thinking / SelfInitiative: Resourceful critical thinker who can prioritize tasks essential to achieving desired outcomes demonstration of an initiativetaking commitment to task completion and the ability to identify and secure necessary resources.
• MultiTasking / Time Management: Proficient in prioritizing and managing tasks to meet evolving deadlines and requirements amidst a demanding and challenging environment characterized by high volume and stress.
• Organizational Skills: Skilled in coordinating people and tasks adeptly adjusting to changing priorities mastering systems efficiently within time constraints and utilizing available resources with diligence.
• Problem Solving / Analysis: Proficient in problemsolving through systematic process analysis guided by sound judgment and grounded in a practical grasp of pertinent issues.
• Team building / Collaborator: Able to influence the actions and opinions of others in a positive direction and build group engagement.
• Technical Skills: Thorough knowledge of Case Management Utilization Management TRICARE policies and procedures HIPAA Privacy and Security regulations URAC accreditation standards Managed Care concepts Behavioral Health practices and principles Medicaid and Medicare eligibility requirements and benefits community resources alternative funding programs and medical management system. Proficiency in basic medical coding principles.

Working Conditions:

• Ability to cover any work shift.
• Ability to work overtime if needed
• Onsite: Works within a standard office environment
• Remote: Private and secure workspace and workstation with highspeed internet is required
• Extensive computer work with prolonged sitting wearing of headset typing speaking on a phone.