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The Care Manager plans and manages behavioral and/or physical care with members and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care and medical attention and addresses identified member needs across the continuum of care. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of the member’s health care services. The Care Manager is assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc. The Care Manager will provide care management services to vulnerable and high-risk Medicaid Members, including persons living with HIV/AIDS. The Care Manager will reach out to members to identify barriers to care and medication adherence and will identify goals and interventions that improve health and support viral load suppression, chronic disease management and access to community supports. This role will operate in a hybrid capacity (field-based settings and telephonically) requiring 1-2 field visits per week in high-risk/medically frail member’s homes or local healthcare facilities.
Job Responsibility:
Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits
Conducts assessments to identify barriers and opportunities for intervention
Develops care plans that align with the physician’s treatment plans and recommends interventions that align with proposed goals
Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement
Collaborates with provider doctors, social workers, discharge planners, and community based service providers to coordinate care accordingly
Coordinates and facilitates with the multi-disciplinary health care team as necessary in order to ensure care plan goals are achieved and maximize member outcomes
Assists in identifying opportunities for alternative care options based on member needs and assessments
Evaluates service authorizations to ensure alignment and execution of the member’s care and physician treatment plan
Contributes to corporate goals through ongoing execution of member care plans and member goal achievement
Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures
follows up as needed
and updates care plans based on member needs, as appropriate
Occasional overtime as necessary
Additional duties as assigned
Requirements:
NYS RN or LCSW, LMSW
Ability to travel around downstate New York which includes the 5 boroughs, Long Island, and Westchester
Nice to have:
Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing crisis situations
Fluency in Spanish
Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors
Knowledge of InterQual and LOCADTR
Experience managing member information in a shared network environment using paperless database modules and archival systems
Experience and knowledge of the relevant product line
Relevant work experience preferably as a Care Manager
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems