Public Consulting Group, Inc. (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide. PCG’s Health practice offers in-depth programmatic knowledge and regulatory expertise to help state and municipal health agencies respond to regulatory change, improve access to health care, maximize program revenue, improve business processes, and achieve regulatory compliance. Using industry best practices, PCG’s Health team helps organizations deliver quality services with constrained resources to promote improved client outcomes. To learn more, visit http://www.publicconsultinggroup.com/health/.
PCG is currently seeking a qualified Case Manager. The Case Manager will be responsible for assisting enrollees of a publicly administered Medical Fund on behalf of a state agency. The Case Manager will be charged with helping program recipients, family members, and caretakers navigate healthcare benefits offered through this Fund. The Case Manager will also be responsible for utilizing a case management software system on a day-to-day basis. The purpose of the Fund is to provide a funding source for future health care costs associated with birth‐related neurological injuries.
The Case Manager will also assist in development of program policies and procedures, and program improvement processes. The Fund operations include, performing assessments, providing case management services, assisting families and program recipients through prior approval of certain healthcare services, and collaborating with the claim’s administration team. Successful candidates will be accountable for the full patient care cycle.
- Responsible for helping program recipients, family members, and caretakers navigate healthcare benefits
- Assists in the development of program policies and procedures
- Responsible for the full patient care cycle.
- Assesses, plans, implements, monitors and evaluates actions required to meet the client’s health and human services needed.
- Coordinates and provides care that is safe, timely, effective, efficient, equitable, and client-centered
- Handles case assignments, draft service plans, review case progress and determine case closure
- Travels within the State to conduct periodic in person assessments
- Facilitates multiple care aspects (case coordination, information sharing, etc.)
- Helps patients make informed decisions by acting as their advocate regarding their clinical status and treatment options
- Develops effective working relations and cooperate with medical team throughout the entire case management process
- Interacts with patients to keep track of their progress and to ensure satisfaction
- Records case information, complete accurately all necessary forms and produce statistical reports
- Document all care activity via case management software system
- Promotes quality and cost-effective interventions and outcomes
- Assesses and addresses motivational and psychosocial issues
- Adheres to professional standards as outlined by protocols, rules and regulations
- BS degree in related healthcare field
- Current license, certification or registration as a Registered Nurse or Social Worker
- 2+ years of experience working with pediatrics; experience or educational training in health or social services, preferably including work experience or a practicum that involved the performance of assessments and the development of case management plans.
Preferred Skills and Experience:
- Excellent communication, interpersonal and client-facing skills.
- Ability to work independently and on a team.
- Proven working experience in case management, including as a nurse, medical, mental health care manager or a social worker
- Excellent knowledge of case management principles, healthcare management and reimbursement
- Previous experience working with case management software
- Previous experience with psychological aspects of care
- Effective communication skills
- Excellent organizational and time management skills
- Familiarity with professional and technical emerging knowledge
- Problem solving skills and ability to multi-task
- Compassionate with teamwork skills
- Bilingual English/Spanish