Care Manager-Quality Assurance

Job Description

Job Description

Overview

Work in conjunction with diverse clinical teams and utilize community resources to meet the needs of individuals receiving care management services. Provide services in accordance with care management service requirements set by the state and company. Responsible for developing and monitoring Tailored Care Management care plans and Individual Support Plans (ISPs) built from comprehensive assessments to an assigned caseload.

Responsibilities

• Develops positive relationships among and between members, family / guardians, Extenders, clinical and care team members and other community stakeholders to create an environment of compassion and professionalism, driving toward positive health and quality of life outcomes.
• Responds proactively to alerts from Extenders concerning unmet health-related needs and identified barriers and gaps to reduce adverse health and quality of life indicators.
• Develops positive relationships with all funding sources that exhibits the willingness to obtain common objectives related to care management.
• Engages the member / family / guardian to establish rapport and provide required and as needed contact, ensuring service provision is up to date and follow through is completed.
• In conjunction with the member, selects members for the care team (adjusting as needed).
• Conducts the Comprehensive Health Assessment on the member, with stakeholder input, to obtain baseline information needed to formulate a care plan.
• Coordinates, schedules, sets the agenda for and assists the member in chairing care team meetings (times, dates, locations, etc.) and informs all team members.
• Develops, implements, reassesses, oversees the implementation of and evaluates the Care Plan / ISP for the member to ensure that the members health needs are addressed in a comprehensive, holistic, and preventive manner, with quality as a goal.
• Manages care transitions and transition plans.
• Ensures medication monitoring and reconciliation occur.
• Monitors / implements / supervises delivery of service plans and personal futures plan and training of staff.
• Documents all information gathered / received electronically in a timely manner.
• Provides documentation of billable events that align with minimum contact expectations to the Care Management Supervisor.
• Maintains an accurate, up-to-date electronic information data stream on all interactions, encounters, activities, care team meetings, and communications with the member / family / guardian.
• Promotes and coordinates comprehensive care among medical, pharmaceutical, psychosocial, social, mental, physical, home health, ancillary providers, and other community agencies, supporting individuals with referrals as needed.
• Connects members with medical, mental, developmental, psychosocial, housing, transportation, home health, and community support services / systems to achieve a comprehensive, holistic, preventive approach.
• Empowers the member / family / guardian and other team members with knowledge that aids in implementing the care plan, treatment plan, medication regimen, and appointment keeping.
• Identifies barriers, gaps, and unmet health-related needs are addresses them proactively, expanding relationships and linkages to aid in meeting member’s needs.
• Supervises up to two FTEs of care management extenders.
• Provides services that meet national, state, and local healthcare standards at the highest level.
• Reports issues of concern, general departmental activities and staffing needs to the Care Management Supervisor.

Completes all required training and participates in educational sessions to improve overall skills.

Attends industry meetings, training, and functions to promote positive relationships with stakeholders.

Participates in quality improvement and measurement activities to achieve identified targets and outcomes.

Completes other duties as assigned.

Qualifications

Qualifications :

Education :

For care managers serving members with LTSS needs : two years of prior LTSS and / or HCBS coordination, care delivery monitoring, and care management experience, in addition to the requirements cited above. (This experience may be concurrent with the two years of experience working directly with individuals with I / DD, or a TBI, above.)