Healthplan Care Manager

Purpose / belief statement :

The position of Care Manager is part of Healthcare Services and reports to the Director of Care Coordination who reports to the VP of Healthcare Services and Quality Operations. This position will have strong working relationships with the Chief Medical Officer and other key contributors across the enterprise. The Care Manager will be responsible for coordinating member-care, developing actionable care plans, communicating effectively and ensuring high-quality healthcare services are delivered to members in an institutional setting within a special needs plan (ISNP).

Job duties & responsibilities

• Care Coordination

Oversee and coordinate the care of assigned ISNP members, ensuring they receive timely and appropriate care as dictated by the SNP Model of Care. Average caseload of 75-100 ISNP members with the ability to cross cover other clinicians as deemed necessary.

Performs initial, annual, transition of care (TOC) and change in condition health risk assessments (HRA) for ISNP care managed caseload. Assessments may include, but are not limited to additional assessments such as PHQ-9, MMSE, Medication Reconciliation, Advanced Directives, etc. The health risk assessment includes a systematic and pertinent collection of data about the health status of the member and requires the member / representative input. Accurate assessment determines cadence of visits / needs and frequency / intensity of care management oversight. Risk stratification is dictated by the specifics within the Model of Care and evaluated with each member interaction.

Collaborates with the interdisciplinary team (ICT) which may include Medical Director, PCP, nurse practitioners / physician assistants, pharmacy, dietary, social workers, other clinical and non-clinical disciplines, facility staff, member representatives and family to establish, revise and continuously evaluate the member centric care plan and conduct documented interdisciplinary care team meetings to be able to work proactively rather than reactively. Care Manager will work closely with Utilization Management, Compliance and Quality to adhere to the Model of Care and ensure quality assurance, cost efficiency and member safety / satisfaction.

Provide education to members and their families about managing chronic conditions and

promotion of self-management strategies.

Maintain accurate and timely documentation of member care activities and any interaction related to the member in compliance with healthcare regulations.

Qualifications & Experience requirements

Knowledge / Skills / Abilities

Work environment