RN Case Manager

General Responsibilities

Works with the elderly and the disabled who are at-risk of entering a nursing home by exploring their options and alternatives to institutional care.

The Supports Coordinator Team, consisting of a Social Worker and RN, complete comprehensive assessments of participants, with a strong emphasis on Person Centered Planning and participant direction.

• Assists participants with securing Medicaid eligibility for Waiver services and monitoring for ongoing program eligibility.
• Using the principles of Person-Centered Planning, the Care Management Team develops care plans with each participant, addressing and honoring the individual's specific needs and desires.
• Conducts assessments as a member of a professional team. Assessments include an evaluation of the consumer's physical and mental health, functional capabilities and limitations, informal and formal support systems, physical environment, and financial resources.
• Completes periodic reassessments as a team or individual
• Schedules, coordinates, and monitors the services according to the person-centered plan, including those covered through the Medicaid Waiver and Bureau of Aging, Community Living, and Supports (ACLS Bureau).
• Maintains accurate files with all the mandatory documents including ACLS Bureau and Medicaid Waiver documentation. Includes the use of a computer to enter information into program software and established database system.
• Adhere to agency and program standards, and ACLS Bureau and MDHHS Supports Coordinator Performance Criteria.
• Participate in Quality Assurance activities.
• Completes follow-up of all services arranged as determined in the person-centered care plan and adjusts as needed.
• Provides advocacy on behalf of participants to secure services and benefits to which they are entitled and promotes participant freedom of choice.
• Maintains shared caseload in conjunction with the RN or Social Work Supports Coordinator. As part of the teamwork practice, back-up is provided to the other Supports Coordinator.
• Updates knowledge pertinent to the provision of services to the elderly and persons with disabilities through attendance at agency and community meetings and continuing education opportunities.
• Establish and maintain working relationships with physicians, hospital discharge staff, nursing home staff, home health and other service providers.
• Covers 24-hour on-call services as scheduled.

Essential Job Functions

• Assists participants with securing Medicaid eligibility for Waiver services and monitoring for ongoing program eligibility.
• Using the principles of Person-Centered Planning, the Care Management Team develops care plans with each participant, addressing and honoring the individual's specific needs and desires.
• Conducts assessments as a member of a professional team. Assessments include an evaluation of the consumer's physical and mental health, functional capabilities and limitations, informal and formal support systems, physical environment, and financial resources.
• Completes periodic reassessments as a team or individual
• Schedules, coordinates, and monitors the services according to the person-centered plan, including those covered through the Medicaid Waiver and Bureau of Aging, Community Living, and Supports (ACLS Bureau).
• Maintains accurate files with all the mandatory documents including ACLS Bureau and Medicaid Waiver documentation. Includes the use of a computer to enter information into program software and established database system.
• Adhere to agency and program standards, and ACLS Bureau and MDHHS Supports Coordinator Performance Criteria.
• Participate in Quality Assurance activities.
• Completes follow-up of all services arranged as determined in the person-centered care plan and adjusts as needed.
• Provides advocacy on behalf of participants to secure services and benefits to which they are entitled and promotes participant freedom of choice.
• Maintains shared caseload in conjunction with the RN or Social Work Supports Coordinator. As part of the teamwork practice, back-up is provided to the other Supports Coordinator.
• Updates knowledge pertinent to the provision of services to the elderly and persons with disabilities through attendance at agency and community meetings and continuing education opportunities.
• Establish and maintain working relationships with physicians, hospital discharge staff, nursing home staff, home health and other service providers.
• Covers 24-hour on-call services as scheduled.

Knowledge, Skills & Abilities

• Commitment to the organization's missions and goals.
• Computer skills sufficient to learn specific departmental software programs.
• Ability to maintain confidential information regarding all aspects of participant, volunteer, employee, and agency information.
• Ability to work independently or as part of a team.
• Ability to communicate effectively and establish good relationships with staff, participants, volunteers, and vendors.
• Ability to represent the Agency in a professional manner.
• Must be able to adjust priorities to meet deadlines in a timely manner.
• Ability to meet department standards regarding job knowledge, participant focus, initiative, productivity, communication, teamwork, and attendance.
• Knowledge of community services and resources.
• Strong assessment skills.

Required

• Current Michigan Registered Nurse (RN) license in good standing
• One year of nursing experience
• Valid Michigan driver's license with acceptable driving record

Preferred

• Experience with aging services, long-term services and supports, or Medicaid Waiver programs

Working Conditions

• When in the office, safe work practices in regard to office equipment, avoiding trips/falls and fire regulations are required.
• When traveling to or spending time at residential or medical facilities, exposure to unusual elements such as smoke, unpleasant odors, loud noises, and extreme temperatures increases.
• Physical mobility is required for sitting, walking, standing, bending, and lifting/holding/carrying objects of up to 20 pounds.
• Must be able to move around in multiple locations with varying barriers and physical environments.
• Must be able to drive.
• Ability to enter and access information using a computer.
• Must be able to communicate effectively with participants, co-workers, and vendors in person and over the telephone.
• Sensory requirements include exposure to varying temperatures, noise levels, environments, and activities.
• Mental requirements include the ability to handle varying and intense levels of stress.

Application Information

To view the complete posting and to apply online visit, https://tcoa.isolvedhire.com/jobs/

To apply in person, visit us at Tri-County Office on Aging, 5303 S. Cedar, Suite 1, Lansing, MI 48911.

Tri-County Office on Aging is an Equal Opportunity Employer.