Care Manager

Role Overview

The Care Manager (RN/SW) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN/SW) engages behavioral health members, member caregivers, and providers to assess, plan, and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care coordination program. In addition, the Care Manager will oversee these same care management activities within assigned practices to ensure the ACDE delivers high-quality care management services following Plan, NCQA, Federal/State standards and requirements.

Work Arrangement

Remote with up to 50% required travel throughout the state of Delaware.

Responsibilities

• Assesses members through face-to-face encounters and by telephone to determine care coordination and care management needs for all referred members.
• Completes comprehensive person-centered assessment, inclusive of physical health history, mental health history, social determinants of health, and supportive needs.
• Carefully coordinates physical, behavioral health, and social services.
• Provides medication management, including regular medication reconciliation and support of medication adherence.
• Identifies problems/barriers for care coordination and appropriate care management interventions.
• Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health.
• Sets goals and assigns priority with associated time frames for completion.
• Shares goals with the member and family as appropriate.
• Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress.
• Schedules follow-up calls as necessary and makes appropriate referrals.
• Implements actions to address member issues.
• Documents progress towards meeting goals and resolving problems.
• Carefully coordinates care and services with the Community Health Navigator and member, member caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers.
• Provides transitional care management.
• Makes regular visits with designated partners regarding plan-identified members for care management, assists with reducing/resolving problems and or barriers so that the ACDE Care Coordinator may provide members with high-quality care management services.
• Participates in regularly scheduled meetings as needed.

Experience

Minimum of 3 to 5 years’ experience with complex medical and behavioral health adult and pediatric populations required. Ability to work with specific care teams and other engagement community partners preferred. Case management experience, preferably within a managed care organization, is desired.

Skills & Abilities

• Demonstrate ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a team member in a fast-paced, ever-changing environment.
• Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.
• Proficient with various technologies including Microsoft Tools and Medical Record systems.
• Strong organizational and time management skills with the ability to promptly prioritize and follow through on multiple items.
• Knowledge and experience in assessing members’ situations, developing a care plan, and teaching self-management.

Benefits

Comprehensive benefits package, Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.