Care Manager - Cluster Care
- The manager is flexible with the start time.
- Care Manager usually get started between 9am and 10am.
- This business unit is experiencing growth and is in need of a Care Manager RN.
- The selected candidate will oversee the care of member who will be transitioning to the community.
- He/She will be assigned to 1-2 transitional homes.
- The member caseload of about 125.
- Responsible for the assessment, reassessment, care planning and coordination of care and services.
- Includes ongoing monitoring of an appropriate and effective person centered care plan, member education and care management.
- Regularly communicates with the members PCP and other providers, and integrates the member, caregiver and other provider feedback into the assessment and planning.
- Completes UAS and other relevant screening and assessment tools in the member home.
- Ensures continuity of care for newly enrolled members.
- Identifies and prioritizes the member s needs and preferences.
- Develops quantifiable goals and desired outcomes, and promotes the members ability to self-manage to the greatest extent possible.
- Develops, implements and monitors the Person Centered Service Plan, assisting members in obtaining reasonable accommodations when appropriate.
- Manages case load, including risk stratification of members, monitoring reassessment needs and facilitating transitions of care settings.
- Serves as the primary point of member contact.
- Assesses member needs, manages care and services, and ensures effective communication among members, caregivers, providers and community supports.
- As the lead of the interdisciplinary team, facilitates the activities and communication within an interdisciplinary team of providers, vendors, facilities, discharge planners, field nurses, social workers, care coordinators, and member/caregivers to effectively manage care plans and transitions of care settings.
- Maintains timely, complete and accurate documentation using both hard copy and technology based solutions in compliance with regulatory policies and procedures.
- Gathers and summarizes data for reports.
- Supports initiatives of the Quality Assessment and Performance Improvement Committee.
- All other duties as assigned.
- Valid RN License.
- Bachelor s Degree.
- 2+ years experience in Behavioral Health.
- Clinical experience with a focus in managed care, including disease or case management.
- Home Care, Long-Term Care, MLTC experience preferred, including appropriate support services in the community and accessing and using durable medical equipment (DME).
- Experience in utilization review, concurrent review and/or risk management a plus.
- Understands and is able to apply principals of Care Management and Person Centered Service Planning.
- Ability to apply Care Guidelines and other applicable, evidenced-based clinical guidelines.
- Ability to understand and apply coverage guidelines and benefit limitations.
- Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses (depression, challenging behaviors, Alzheimer s disease and other disease-related dementias).
- Understands and adapts appropriately to issues related to communication, cognitive or other barriers.
- Ability to lead an interdisciplinary care team.
- Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner.
- Comfortable with conducting home visits and commuting within the service area.
A-Line Staffing Solutions