- Professional
Role Overview: The Care Manager is responsible for managing and coordinating care, services, and social determinants of health for members with acute, chronic, medically complex, and/or behavioral health conditions and other health needs. Serves as the primary point of contact for the care team that includes members, physicians, and community supports to guide members in achieving their optimal level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care, and barriers to care. Develops a plan of care through shared decision making with the member/caregiver and in collaboration with providers and other care team members to improve the member’s health status, compliance with treatment plans, and promote self-management.
Work Arrangement:
- Remote – Associate must be located in Ohio.
Responsibilities:
- Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the effectiveness of the plan.
- Review medication list, educate members on pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.
- Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the member/caregiver's progress, needs, and preferences.
- Establishes points of contact to collaborate with identified community, medical, and/or behavioral health teams.
- Maintain timely, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable.
- Monitor appropriate utilization and coordinate services with other payer sources, make appropriate referrals, identify, and escalate quality of care issues.
- Develop a working knowledge of ACFC electronic care management platforms, care management programs, policies, standard operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements.
- May identify cases to be presented at care management rounds and follow up with providers on recommendations to achieve optimal outcomes for Members.
- Support a positive workplace environment, collaborate, and share clinical knowledge and skills to help our culturally and demographically diverse Member population. Face-to-face visits may be required at the Member’s residence, provider’s office, hospitals, other acute locations, or community locations for education and/or assessment.
- Other duties as assigned.
Education & Experience
- Current, unrestricted Ohio RN license in good standing. Associate degree in nursing required. Bachelor’s degree preferred.
- Bachelor’s or master’s degree in social work and a current, unrestricted Ohio LSW/LMSW/LISW/LPC license in good standing.
- Minimum of 3 years of professional practice working with adults and/or pediatric patients with behavioral and physical health disorders, maternal health, oncology, transition of care/discharge planning within an acute care, community health, or ambulatory care setting.
- Case management experience, preferably within a managed care organization.
- Proficiency using MS Office (Word, Excel, Outlook, Teams), SharePoint, internet applications, and electronic medical record and documentation programs.
Licensure:
- A current and unrestricted Registered Nurse (RN) or Licensed Independent Social Worker (LISW) in Ohio or multi-state compact licensure is required.
- Valid driver’s license and car insurance.
Skills & Abilities:
- Ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team in a fast-paced, ever-changing environment.
- Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.
- Strong organizational and time management skills with the ability to prioritize and follow through on multiple items in a timely manner.
- Knowledge and experience in assessing the member’s situation, developing a care plan, and teaching self-management.
