Job: Care Manager

Responsible for members gaining access to needed services and coordination and integration of medical and long-term care services. She/he is responsible for ensuring cost effective and efficient utilization of health plan services. Care manager acts as member advocate, seeking and coordinating solutions to long term care needs without compromising quality of outcomes. Conducts on-site visits to member’s place of residence, hospitals, nursing homes, etc., for the purpose of orientation, care plan development, assessment, and care coordination.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Completes assessments and /or protocols through interaction with member/caregiver/provider.

Acts as advocate for member needs.

Orients new members to plan benefits and procedures, and is a resource for members on an ongoing basis.

Identifies cases for potential risks/complications.

Develops and modifies member’s care plan based on assessments and other information.

Obtains information regarding client status, support system, and need for services on an ongoing basis.

Monitors delivery of services and follows up with members/caregivers/providers as necessary, including field visits.

Applies knowledge of community resources and government initiatives that affect members.

Orients providers regarding plan benefits and procedures as they pertain to services members receive.

Maintain awareness of laws, regulations, and long term care/medical environment keeping abreast of changes that may affect program through training programs, seminars, and peer contact.

Establishes working relationships with community agencies, providers, and others involved with members.

Document information timely, and accurately reflect identified problems, interventions, member concerns, and effectiveness of services provided.

Assist in quality improvement activities.

Request supervisor’s assistance, as needed, on complex and /or non-routine issues.

Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services.

Maintain a positive work atmosphere by behaving and communicating in a manner that promotes harmonious relationships with members, caregivers, providers, staff, and other departments.

Report issues to supervisor as necessary.

Other duties as requested or assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Strong verbal and writing communication skills

Computer literate and knowledge of word processing

Knowledge of Medicare and Medicaid programs

Knowledge of medical terms

Excellent problem solving skills

Customer focus

Appreciation of cultural diversity and sensitivity towards target population

Some travel required (valid drivers license and access to a car)

EDUCATION and/or EXPERIENCE

Bachelor’s degree

At least one year experience in long term care, family services or healthcare field

Case management experience

During employment: at least four hours of service training annually