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Oversees the care for long term support services / long term care populations and provides coordination of care services for lower acuity individuals living in the community or nursing facilities. Ensures a comprehensive assessment of member's care needs and status, interdisciplinary team approach, and education of members. Works closely with internal and external partners to achieve optimal health care outcomes for the member through effective coordination of care activities.
Reports to: Mgr, Non-Clinical Field CM
Department: Mer- IL- Case Mgmt
Coordination and care management of members with lower utilization of home community services (i.e. members attending adult day care services or those who are stable on current medication / treatment regimens).
Manages an active caseload based on state mandated ratios according to residential setting, case intensity and acuity.
Ensures comprehensive assessments are completed within required time frames and utilizes knowledge and expertise to assess options for care including use of benefits and community resources.
Partners effectively with the PCP, Specialist, member, member’s family and integrated care teams (ICT) to develop a Person Centered Care Plan.
In partnership with the member, family, physician(s), ICT and other providers, assesses short and long term member needs, evaluates the need for alternative services and establishes member driven care management objectives.
Responsible for coordination of service authorizations (i.e. meals, transportation, activities of daily living).
Educates on and coordinates community resources with emphasis on medical, behavioral and social services. Applies care management standards and maintains HIPAA standards and confidentiality of protected health information.
Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
Performs special projects as assigned.
Required Other For Florida LTC and IL LTSS: a Bachelors degree in social work, sociology, psychology, gerontology, or other related social services field
Preferred Other For Florida LTC and IL LTSS: a Masters degree in social work, sociology, psychology, gerontology, or other related social services field
Required Other For Florida LTC and IL LTSS, must meet one of the following: *Possess a minimum of two (2) years of relevant experience and have a Bachelor’s degree in social work, sociology, psychology, gerontology, or a related social services field; or * Possess a master’s degree in social work, sociology, psychology, gerontology, or a related social services field may substitute experience obtained through a practicum, internship, or clinical rotation on an equivalent basis for up to one (1) year of the experience requirements; *Non-degreed candidates may substitute professional human service experience on a year-for-year basis for the educational requirement with a minimum of six (6) years of relevant experience.
Intermediate Demonstrated written communication skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Knowledge of healthcare delivery
Intermediate Ability to work as part of a team
Intermediate Ability to work independently
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Demonstrated organizational skills
Intermediate Other Ability to remain calm under pressure
Licenses and Certifications: A license in one of the following is required:
Required Other For FL only: CPR Certified
Preferred Certified Case Manager (CCM)
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Required Intermediate Healthcare Management Systems (Generic)