Case Management Care Manager

About the role

Work in conjunction with diverse clinical teams and utilize community resources to meet the needs of individuals receiving care management services. Provide services in accordance with care management service requirements set by the state and company. Responsible for developing and monitoring Tailored Care Management care plans and Individual Support Plans (ISPs) built from comprehensive assessments to an assigned caseload.

Responsibilities

• Develop positive relationships among and between members, family/guardians, Extenders, clinical and care team members and other community stakeholders to create an environment of compassion and professionalism, driving toward positive health and quality of life outcomes.
• Respond proactively to alerts from Extenders concerning unmet health-related needs and identified barriers and gaps to reduce adverse health and quality of life indicators.
• Develop positive relationships with all funding sources that exhibits the willingness to obtain common objectives related to care management.
• Engage the member/family/guardian to establish rapport and provide required and as needed contact, ensuring service provision is up to date and follow through is completed.
• In conjunction with the member, select members for the care team (adjusting as needed).
• Conduct the Comprehensive Health Assessment on the member, with stakeholder input, to obtain baseline information needed to formulate a care plan.
• Coordinate schedules, set the agenda for and assist the member in chairing care team meetings (times, dates, locations, etc.) and inform all team members.
• Develop, implement, reassess, oversee the implementation of and evaluate the Care Plan/ISP for the member to ensure that the member’s health needs are addressed in a comprehensive, holistic, and preventive manner, with quality as a goal.
• Manage care transitions and transition plans.
• Ensure medication monitoring and reconciliation occur.
• Monitor/implement/supervise delivery of service plans and personal futures plan and training of staff.
• Document all information gathered/received electronically in a timely manner.
• Provide documentation of billable events that align with minimum contact expectations to the Care Management Supervisor.
• Maintain an accurate, up-to-date electronic information data stream on all interactions, encounters, activities, care team meetings, and communications with the member/family/guardian.
• Promote and coordinate comprehensive care among medical, pharmaceutical, psychosocial, social, mental, physical, home health, ancillary providers, and other community agencies, supporting individuals with referrals as needed.
• Connect members with medical, mental, developmental, psychosocial, housing, transportation, home health, and community support services/systems to achieve a comprehensive, holistic, preventive approach.
• Empower the member/family/guardian and other team members with knowledge that aids in implementing the care plan, treatment plan, medication regimen, and appointment keeping.
• Identify barriers, gaps, and unmet health-related needs and address them proactively, expanding relationships and linkages to aid in meeting member’s needs.
• Supervise up to two FTEs of care management extenders.
• Provide services that meet national, state, and local healthcare standards at the highest level.
• Report issues of concern, general departmental activities and staffing needs to the Care Management Supervisor.
• Complete all required training and participate in educational sessions to improve overall skills.
• Attend industry meetings, training, and functions to promote positive relationships with stakeholders.
• Participate in quality improvement and measurement activities to achieve identified targets and outcomes.
• Perform other related duties and activities as required.

Supervisory Responsibilities

None

Minimum Knowledge and Skills Required for the Job

Education and Experience

• Two years of experience as a Care Manager, Case Manager, or Care Coordinator preferred
• A license, provisional license, certificate, registration, or permit issued by the governing board regulating a human service profession, except a registered nurse who is licensed to practice in the State of North Carolina by the North Carolina Board of Nursing who also has four years of full-time accumulated experience with the IDD population; or
• A Master’s degree in a human service field and one year of full-time, post-graduate degree accumulated experience with the IDD population; or
• A bachelor’s degree in a human service field and two years of full-time, post-bachelor's degree accumulated experience with the IDD population; or
• A bachelor’s degree in a field other than human services and four years of full-time, post-bachelor's degree accumulated experience with the IDD population; and
• For care managers serving members with LTSS needs: two years of prior LTSS and/or HCBS coordination, care delivery monitoring, and care management experience, in addition to the requirements cited above. (This experience may be concurrent with the two years of experience working directly with individuals with I/DD, or a TBI, above.)

Certificates, Licenses, and Registrations

Must meet all agency requirements for pre-employment and those required by state

Other Skills and Abilities

• Ability to perform work with a high degree of quality and autonomy

Other Requirements

• Travel as needed

Physical Requirements

Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.