Clinical - LTSS Service Care Manager

Job Title: ClinicalLTSS Care Manager

Location: Guilford County, NC

Pay: Competitive salary based on experience

Responsibilities

• Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes.
• May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.
• Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome.
• Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialists, and/or community resources needed for long-term care.
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members.
• Provides resource support to members and their families/caregivers for various needs (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans.
• Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs.
• Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met.
• Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
• May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners.
• Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits.
• Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.
• Performs other duties as assigned.
• Complies with all policies and standards.

Typical Day in the Role

• Managing a case load for healthcare members with LTSS (Long Term Support/Services) needs.
• Monthly and quarterly member contact and will include 80% travel. Remote role. Will require a driver’s license.
• Member assessments and notes.
• Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development.
• Monitor delivery of services and follow-up with members, caregivers, or providers through in-person visits and telephonic contact.
• Authorize and coordinate referral for services.
• Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care.
• Assist in coordinating the development of informal or voluntary services to integrate into the member care plan.
• Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long-term care services.
• Assist member with filing and resolving complaints and appeals.

Candidate Requirements

• Education/Certification: Required: Bachelor’s
• Licensure: Required: RN
• Years of experience required: 2-4 years of physical health care management experience, 4-6 years of physical health care management experience preferred. Hospital CM, Home health, discharge planning, or long-term care experience preferred.
• Disqualifiers: No Psych experience such as counseling (must have bedside case management hospital physical as well) no Right out of nursing school. No Nursing homes. No rehab.
• Additional qualities to look for: Virtual, All Microsoft office, Experience with electronic medical health records.
• Top 3 must-have hard skills stack-ranked by importance:
  • RN and/or LCSW Physical hospital Health, Care Management, Utilization Mgt, Home Health - all and/or background
  • Microsoft office
  • Bedside care management

Seniority Level

Mid-Senior level

Employment Type

Contract

Job Function

Health Care Provider

Industries

Staffing and Recruiting