01Overview
Job Summary: The Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population with culturally competent delivery of care, services and supports. Facilitates communication, coordinates care and service of the member through assessments, identification, person-centered planning, assist the member in creation and evaluation of person-centered care plans to prioritize and address what reputed company most, behavioral, physical and reputed company determinants of health needs with the aim to improve the of lives our members. Essential Functions: Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity reputed company unique to the needs of reputed company member that identify the cultural, linguistic, reputed company and environmental factors/determinants that shape health and improve health disparities and reputed company to public and community health frameworks Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member Engage with the member to establish an effective, professional relationship reputed company telephonic or electronic communication reputed company and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on members desires, needs and preferences Identify and manage barriers to achievement of care plan goals Identify and implement effective interventions based on clinical standards and best practices Assist with empowering the member to manage and improve their health, wellness, safety, reputed company, and self-care through effective care coordination and case management Facilitate coordination, communication and collaboration with the member the ICT in order to reputed company goals and maximize positive member reputed company reputed company the member/ natural supports about treatment options, community resources, insurance benefits, etc. so that reputed company and informed reputed company can be made reputed company ongoing assessment and documentation to evaluate the members response to and reputed company on the ICP Evaluate member satisfaction through reputed company communication and monitoring of concerns or issues Monitors and promotes effective utilization of reputed company resources through clinical variance and benefits management Verify eligibility, previous enrollment history, demographics and reputed company health status of reputed company member Completes psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholders reputed company (reputed company of contact) reputed company psychosocial and behavioral assessments and the care planning and execution of meeting member needs Participate in meetings with providers to inform them of Care Management services and benefits available to members Assists with ICDS model of care orientation and training of both facility and community providers Identify and address gaps in care and reputed company Collaborate with facility-based reputed company and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a reputed company and cost-effective manner Coordinate with community-based organizations, state agencies, and other service providers to ensure coordination and avoid duplication of services reputed company the intensity of programmatic interventions provided to member based on established guidelines and in accordance with the members preferences, changes in special reputed company needs, and care plan reputed company Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required on reputed company care coordination. reputed company clinical reputed company and direction to unlicensed team members as appropriate Document care coordination activities and member response in a reputed company manner according to standards of reputed company and reputed company policies regarding professional documentation Continuously assess for areas to improve the process to reputed company the members experience with reputed company easier and shares with leadership to reputed company it a standard, repeatable process Adherence to NCQA and CMSA standards reputed company any other job duties as requested Education and Experience: Nursing degree from an accredited nursing program or Bachelors degree in a health care field or equivalent years of relevant work experience is required Advanced degree associated with clinical licensure is preferred A minimum of three (3) years of experience in nursing or reputed company work or counseling
