Care Manager IDD

Assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. Engages members, member caregivers, and providers to assess, plan, and establish individual member goals. Facilitates and coordinates care for members while assuring quality and use of cost-effective resources. Functions as a single point of contact and advocate for members in the care coordination program. 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 Kent and Sussex counties.

Responsibilities

• Assess 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.
• 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.
• Identifies 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 within EMR system.
• 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.
• Meets regularly 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.
• Participate in regularly scheduled meetings as needed.

Requirements

• Minimum of 3 to 5 years experience with the behavioral health population required.
• Experience working with individuals with Intellectual Developmental Disabilities population preferred.
• Knowledge of 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.

Licensure

• 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, 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.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.