The Care Manager (RN/SW) will:
- Assist members appropriate for care coordination and case management services in achieving their optimal level of health.
- Be responsible for engaging the member and providers to assess, plan and establish individual member goals.
- Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources.
- Function as a single point of contact and be an advocate for members in the care coordination program.
- Assess members to determine care coordination and case management needs for all referred members.
- Complete comprehensive assessment of environmental, psycho-social and support needs.
- Identify problems/barriers for care coordination and appropriate care management interventions.
- Create a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health.
- Identify both short and long term goals and associated time frames for completion.
- Share goals with the member and family as appropriate.
- Identify and implement the appropriate level of intervention based upon the member's needs and clinical progress.
- Schedule follow up calls as necessary, make appropriate referrals.
- Implement actions to address member issues.
- Document progress towards meeting goals and resolving problems.
- Coordinate care and services with the Account manager, Complex RN Case Manager, and member, family members as appropriate, PCP, Specialist, and Facility/Vendor Providers.
- A Bachelor's Degree degree in a health related field and licensure as a health professional (where such licensure is available), or
- Master's Degree in a health related field and licensure as a health professional (where such licensure is available); or
- MSW licensure and three (3) years professional practice experience
- Registered Nurse
- Certification as a case manager (as documented and accepted on URAC's website@ www.urac.org)
- Three (3) to five (5) years experience in Case Management
- Active state RN license and Valid driver's license with car insurance
- Current unrestricted Social Worker License
- Maternity, labor and deliver experience preferred.