Care Manager

Job Description

Job Description

Position Summary

Address the needs of the population served by assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required by using communication and available resources to promote quality, cost-effective health outcomes.

Performing within the Registered Nurse and / or Licensed Clinical Social Work scope of practice, collaborate with the Primary Care Provider, member, guardian, caregivers, family members, other members of the Care Management Team, and the community to coordinate a full continuum of health care services. Holistic needs of the member, inclusive of unique social and cultural dynamics should be considered. The Care Manager may work remotely within regions to cover the needs across the state.

Care Manager(s) will serve the population within Regions 2, 4, and 6. Remote and travel will be required within the region and / or the State. Preferred to reside in the following Counties : Randolph, Gilford, Craven, Pitt, orange, Chatham, Carteret, Alamance, and Rockingham Counties.

Essential Functions

• Provide effective Care Management services based on case management standards of practice to enrolled populations.
• Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care.
• Work with members to identify and address behavioral, social, cultural, and environmental strengths and barriers as it relates to his / her diagnosis, treatment, and access to care.
• Provide education to member / family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management.
• Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members / families.
• Develop, review, implement, and evaluate the member care plan in partnership with the member, caregiver / guardian / family members, providers, and Care Management team members, as applicable.
• Incorporate therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities to help members achieve healing, growth, health, and wellness.
• Utilize Hospital / Data or Electronic Medical Record system as available.
• Per guidance, facilitate referrals for members / families to appropriate community-based services and agencies.
• Refer to appropriate clinical team members for interventions which are outside the Care Managers’ scope of practice and / or expertise.
• Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes.
• Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization.
• Serve as a liaison among the member / family / guardian, community services, primary providers, specialists, and other care team members to coordinate services without duplication.
• Respect member’s values, experience, and help to empower members to be an advocate for their own care.
• Maintain appropriate member documentation in the Care Management documentation platform, in accordance with organizational policies and procedures.
• Meet monthly productivity and role expectations.
• Understand, uphold, and abide by CCNC company and department policies, goals, standards, and objectives.
• Adhere to CCNC privacy, security policies, and HIPAA regulations to ensure that patient and company data are properly safeguarded.
• Attend departmental and corporate meetings, local and regional training, or other events as required.
• Travel using personal vehicle will be required within the region and / or the State.
• Perform all other duties as requested.

Qualifications

Registered Nurse (RN)

Social Worker

Knowledge, Skills, and Abilities

Working Conditions