(Archived) social work LSW licensed practical nurse LPN Case Manager- Full time

They use a collaborative process of assessment, planning, implementing, coordinating, monitoring, and evaluating options and services required to meet the members health and social needs. They act as a liaison between our Members, their Responsible Parties and/or Power of Attorneys (RP/POAs), Advance Plan Provider/PCP, and Senior Care stakeholders.

This is an on-site role. This work is mostly in person with some travel. 4 days in the field and flexible scheduling.

§ Contacts Plan members to conduct a comprehensive health assessment of the individual, develop a plan of care, and participate in the facilities interdisciplinary care team meeting.

§ Serves as health coach to educate the member, the family and/or caregiver, about disease status and treatment, plan benefits, community resources, and resource options

§ Collaborates with members of the interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members

§ Routinely follows up with member as scheduled to assess progress towards goals

§ Communicates with the member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals

§ Provide patient-centered intervention; such as making and verifying appointments, performing medication and care compliance initiatives;.

§ Communicates Member health updates from Care Team to RP/POAs.

§ Coordinates with the Care Team for non-urgent health or clinical questions.

§ Works directly with internal departments to solve Member Grievances, Utilization Management, and Billing related issues.

§ Updates Member and RP/POA contact information such as changes of address, email, or phone numbers.

§ Actively supports Account Manager in identifying and securing contracts with "preferred" Providers.

§ Assists Members, RP/POAs, and Partner Communities with locating in-network providers and scheduling/facilitation of appointments.

§ Assists with (on request of member or APP) coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members.

§ Monitors and, if needed, facilitates care team meetings with facility team, member, responsible partie(s) and the APP/clinical team.

§ Ensures documentation of care team meetings and transmits to Plan.

§ Monitors care plan updates, facilitates APP and PCP input into care plan, and distributes care plan as needed to care team members.

§ Monitors midnight reports/community census to help identify member transitions to hospital or other care levels.

Education & Experience

§ Undergraduate or graduate degree in social work (LSW), licensed practical nurse (LPN), or have 5+ experience meeting the needs of the aged, blinded, or disabled population

§ 3-5 years of Case Management experience preferred

§ Medicare or Medicaid knowledge preferred

§ NCQA or URAC experience preferred

§ Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.