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Locates, coordinates, directs, monitors, and assists in determining eligibility for social, medical, financial, and other services (formal or informal) to meet the needs of Community Alternatives Program (CAP) clients. Completes psychosocial assessment, develops and revises the Plan of Care, prepares progress notes, work with the client and family, utilizing appropriate community resources, participates in discharge planning and in-service programs and acts as a consultant to other agency personnel, physicians, hospital staff, CAP providers, and Home Health agencies. Provides, client and family advocacy, crisis intervention, community resources and education, information, and referral for community programs.
Job Responsibility:
Locates, coordinates, directs, monitors, and assists in determining eligibility for social, medical, financial, and other services (formal or informal) to meet the needs of Community Alternatives Program (CAP) clients
Completes psychosocial assessment, develops and revises the Plan of Care, prepares progress notes, work with the client and family, utilizing appropriate community resources, participates in discharge planning and in-service programs and acts as a consultant to other agency personnel, physicians, hospital staff, CAP providers, and Home Health agencies
Provides, client and family advocacy, crisis intervention, community resources and education, information, and referral for community programs
Facilitate the entire service delivery process. Develops and completes client assessments and Plan of Care based on information gathered at the initial assessment and periodic reviews. Enter information into program specific electronic systems according per NC guidelines
Completes necessary forms/notices per NC Medicaid guidelines in the CAP patient electronic and written charts
Monitors the client’s situation to assure the quality of care
the correct level of care
and the continued appropriateness of CAP participation by reviewing provider documentation and claims
obtaining input from the client, family, and service providers
and personal observation
Coordinates with Medicaid income maintenance staff on a regular basis regarding the client’s eligibility for Medicaid and/or Medicaid deductible
Makes home visits (per NC Medicaid guidelines) to ensure services are appropriate and satisfactory according to the Plan of Care and not threatening the client’s health, safety, and well-being. Provides advocacy, emotional support and intervention to clients to strengthen family/support systems, especially when disruptions in services arise due to conflicts
Maintains cost effective service delivery by maintaining and utilizing knowledge of regulations and reimbursement requirements
Collaborates with various disciplines to ensure a comprehensive and holistic approach to client care. Locates and coordinates resources
Promptly investigates complaints and/or errors and takes corrective action when warranted
Documents Case Management in a running narrative in the CAP patient files and includes all contacts and activities related to clinical care. Each entry must contain sufficient detail to support a claim for reimbursement
Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served. Demonstrates knowledge of the principles of growth, development of the life span and possesses the ability to assess data reflective of the client’s status and interpret the appropriate information needed to identify each client’s requirements relative to his or her age specific needs and provides the care needed as described in the departmental policies and procedures
Maintains a high degree of confidentiality due to access of sensitive information
Performs other duties as assigned
Requirements:
Bachelors degree in social work, psychology or other related human services field
Knowledge of Community Alternatives Program CAP/DA and CAP/C policies and procedures preferred
Experience in the evaluation and provision of long-term care services as well as working with children, aged, and disabled preferred
Excellent oral and written communication skills
Ability to multi-task under tight deadlines
Strong communication skills and interpersonal skills
Valid driver’s license and proof of insurance is required