LTSS Service Care Manager - J01031

Job Profile Summary

Position Purpose :

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.

Education / Experience :

Requires a Bachelor's degree and 2 - 4 years of related experience.

Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

RN or LCSW required.

Responsibilities

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, specialist, 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 members 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

IND 123