Care Manager (RN)

Position Summary: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high-quality, cost-effective healthcare outcomes.

Key Responsibilities:

• Required to complete daily outreach calls based on member-specific tiers.
• Based on members' needs, the call volume will vary 5-20 calls per day.
• Contractual obligation is a weighted 200 caseload (Tier 3 - 2.2, Tier 4 - 1).
• Outreach calls are to check in on the members, follow up on their needs, remove any barriers to care for the members.
• Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost-effective care.
• Coordinate care (finding providers).
• Assisting in authorization.
• Creating assessments and care plans.
• Ensuring that the children's needs are met (having issues at school, having a home health aide to assist).
• Leadership will complete chart and call audits on a monthly basis or as needed.

• Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs.
• Identifies problems/barriers to care and provide appropriate care management interventions.
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
• Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs.
• Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate.
• Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services.
• Performs other duties as assigned.
• Complies with all policies and standards