Case Manager II; PTC)

Why work at Rocky Mountain Human Services?

You will have the opportunity to contribute to an organization that is dedicated to embracing the power of community to support individuals and families in creating their future.

RMHS provides great benefits such as:

Employer paid medical options, dental, and vision benefits

Generous paid time off such as vacation, sick, personal, and holidays

Life and disability insurance

Tuition reimbursement (full-time employees only)
Mileage reimbursement
403(B) with company match

Employee assistance program

Position Purpose Case managers serve as the main contact for members receiving Long Term Services and Supports through Medicaid or State Funded programs. The case manager provides specialized, ongoing case management by monitoring services, having communication with members and providers, and coordinating resources and requests as needed. Case managers serve as the experts in eligibility assessments, service plans, and prior authorization requests (PARs).Essential

Duties Responds to correspondence from the member, family or provider within two business days. This can include questions, requests, concerns, status updates, etc.

Completes in-person eligibility and monitoring visits with the member at their residence.

Completes quarterly monitoring visits with the member and/or designated team member as assigned. This may be an in person or virtual visit depending on the client’s preference.

Schedules assigned assessments and service plans with the member and, if appropriate, care team in the timeframe required.

Completes all assigned and required assessments and service plans with the member and, if appropriate, care team in the member’s residence.

Ensures the PAR is completed prior to services being implemented and matches the assessment and service plan.

Completes all CDASS and IHSS required paperwork as part of the annual service plan process.

Submits utilization reviews to the utilization management vendor and responds to all follow up requests in a timely manner.

Coordinates with members and providers to ensure PARs and plans are accurate. Responds to requests for follow up within two business days.

Ensures certifications are submitted to the county to prevent eligibility breaks.

Responds to the complex needs of members and represents RMHS in team meetings to determine services and supports needed to meet the member’s needs.

Assists members and their care teams to find appropriate service providers and/or necessary resources.

Initiates revisions to the service plan by collecting information and understanding the needs of the member and care team.

Completes all necessary paperwork according to rules and regulations to properly implement a rights modification for the member to be safe and healthy.

Monitors and responds to incident reports and critical incident reports.

Responsible for the management of an assigned caseload.

Completes closures or terminations, as needed, ensures members understand the complaint and appeal process.

Maintains professional and ethical behaviors in all interactions with members, care teams, and RMHS internal staff while meeting expectations and quality standards set by RMHS.Participates in training and staff development activities as assigned, including team meetings.

Facilitates team meetings with care teams (primarily for IDD waivers and programs)
Completes Mill Levy requests for members and/or their care team (primarily for IDD waivers and programs)
Completes FSSP and State SLS plans (children’s and state team/CM only)
Performs other duties as assigned.

Knowledge, Skills, and Abilities Communicates professionally and empathetically both verbally and in writing.

Knowledge, understanding and competency about members who have disabilities and members…