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Care Manager for Regions 2 and 4
2 months ago
Community Care of North Carolina Inc is seeking a skilled Care Manager to join our team. As a Care Manager, you will be responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required by our members to promote quality, cost-effective health outcomes.
Key Responsibilities:- Provide effective Care Management services based on case management standards of practice to enrolled populations.
- Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care.
- Work with members to identify and address behavioral, social, cultural, and environmental strengths and barriers as it relates to his/her diagnosis, treatment, and access to care.
- Provide education to member/family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management.
- Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members/families.
- Develop, review, implement, and evaluate the member care plan in partnership with the member, caregiver/guardian/family members, providers, and Care Management team members, as applicable.
- Incorporate therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities to help members achieve healing, growth, health, and wellness.
- Utilize Hospital/Data or Electronic Medical Record system as available.
- Per guidance, facilitate referrals for members/families to appropriate community-based services and agencies.
- Refer to appropriate clinical team members for interventions which are outside the Care Managers' scope of practice and/or expertise.
- Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes.
- Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization.
- Serve as a liaison among the member/family/guardian, community services, primary providers, specialists, and other care team members to coordinate services without duplication.
- Respect member's values, experience, and help to empower members to be an advocate for their own care.
- Maintain appropriate member documentation in the Care Management documentation platform, in accordance with organizational policies and procedures.
- Meet monthly productivity and role expectations.
- Understand, uphold, and abide by CCNC company and department policies, goals, standards, and objectives.
- Adhere to CCNC privacy, security policies, and HIPAA regulations to ensure that patient and company data are properly safeguarded.
- Attend departmental and corporate meetings, local and regional training, or other events as required.
- Travel using personal vehicle will be required within the region and/or the State.
- Perform all other duties as requested.
- Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW)
- Graduation from an accredited school of nursing or social work
- BSN or MSW preferred
- Active, unrestricted RN or LCSW license to practice in North Carolina
- Minimum 2 years' nursing or social work experience; 1-year care management or community-based nursing or social work preferred
- CCM certification preferred; will obtain within 1 year of eligibility per CCM requirements
- Meets licensure or educational eligibility requirements as determined by The Commission for Case Management Certification
- Access to Hospital/Data or Electronic Medical Record system will be required, as necessary
- Maintain a valid driver's license with current auto liability insurance
- Computer skills required including various office software and the internet; experience with MS Office software preferred
- Excellent communication skills – oral and written; Bilingual preferred
- Knowledge of government, private sector, and community resources
- Knowledge of Case Management principles
- Knowledge of and compliance with federal and state regulations applicable to the position
- Strong organizational and time management skills
- Skills in establishing rapport with a member and applying techniques of assessing comprehensive health care needs
- Critical thinking skills, effective clinical judgment, independent decision-making, and problem-solving abilities
- Sensitivity to diversity of cultures, language barriers, health literacy, and educational levels
- Ability to work independently and function as an integral part of a multi-disciplinary team
- Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives
- Able to shift strategy or approach in response to the demands of a situation
- The job environment is primarily an office or home environment
- Multiple contacts, face to face and/or telephonic, are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur
- Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time
- Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices
- Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds
- Travel will be required within the region and/or the State
