Care Manager

About the Role

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 engages members, member caregivers, and providers to assess, plan, and establish individual member goals. They facilitate and coordinate care for members while ensuring quality and use of cost-effective resources, functioning as a single point of contact and advocate for members in the care coordination program. Additionally, the Care Manager oversees care management activities within assigned practices to ensure high-quality services following Plan, NCQA, Federal/State standards, and requirements.

Work Arrangement: Fully Remote with required weekly travel within Sussex County and throughout Delaware state.

Responsibilities

• Assess members through face-to-face encounters and by telephone to determine care coordination and care management needs for all referred members.
• Complete comprehensive person-centered assessments, inclusive of physical health history, mental health history, social determinants of health, and supportive needs.
• Coordinate physical, behavioral health, and social services.
• Provide medication management, including regular medication reconciliation and support of medication adherence.
• Identify problems/barriers for care coordination and appropriate care management interventions.
• Create a plan of care to assist members in reducing/resolving problems and barriers so that members may achieve their optimal level of health.
• Identify goals and assign priority with associated time frames for completion. Share goals with the member and family as appropriate.
• Identify and implement the appropriate level of intervention based on the member’s needs and clinical progress.
• Schedule follow-up calls as necessary and make appropriate referrals. Implement actions to address member issues.
• Document progress toward meeting goals and resolving problems within the EMR system.
• Coordinate care and services with the Community Health Navigator, member, member caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers.
• Provide transitional care management.
• Meet regularly with designated partners regarding plan-identified members for care management, assisting with reducing/resolving problems and barriers so that the ACDE Care Coordinator may provide high-quality care management services.
• Participate in regularly scheduled meetings as needed.

Requirements

• Minimum of 3 to 5 years of experience with the behavioral health population required.
• Experience working with individuals with Intellectual Developmental Disabilities preferred.
• Knowledge of the Life Span Waiver program preferred.
• Ability to work with specific care teams and other engagement community partners preferred.
• Case management experience, preferably within a managed care organization, is desired.
• Proficient with various technologies including Microsoft Tools and Medical Record systems.

Qualifications

• Current, unrestricted DE RN license in good standing or unrestricted DE LMSW / LCSW license with experience in managing medical complexities.
• Valid Driver’s License.

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.
• Proficiency using MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record and documentation programs.
• Demonstrate strong organizational and time management skills with the ability to promptly prioritize and follow through on multiple items.
• Demonstrate knowledge and experience in assessing members’ situations, developing a care plan, and teaching self-management.

Benefits

• Flexible work solutions including remote options and 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.