Assessment and Care Planning Care Manager

The Assessment and Care Planning Care Manager works within the Assessment and Care Planning team to conduct scheduled in-person or telephonic assessments and develop care plans for members whose needs represent high clinical, behavioral and social risk. In-person assessments can occur in member homes, provider offices, hospitals, facilities, adult day centers and other areas. The Care Manager will assist with care coordination for time sensitive service needs and will ensure appropriate referrals are made. Collaborates with internal Care Management and Behavioral Health teams to stratify and hand members off for ongoing case management. In addition, they will also conduct chart review assessments for eligible members. This individual should feel comfortable when working to overcome environmental, cultural and language barriers. This position works directly with members, staff, managers, and both internal/external customers, providers and vendors in the community.

• Practice case management within the scope of licensure.
• Utilizes case management principles and sound clinical judgment in initiating care coordination for a specific member population
• Performs case management functions for identified individuals in order to engage, assess and assist with care coordination including but not limited to:
  • Performing a comprehensive assessment which includes care planning activities including the development of interventions, short and long-term goals in collaboration with member, family, PCP, Behavioral Health Professionals and other involved health care professionals and community agencies, as appropriate
  • Communicate with providers to facilitate needed care
  • Implements care plan, facilitates referrals, coordinates services and resources for needs identified during initial assessment, in preparation for care manager handoff
  • Attends marketing events and completes assessments as needed
  • Off-site visits (such as but not limited to home, hospital or community health centers or other community agencies) as necessary or required
• Reviews members with CM and BH Specialist staff in weekly stratification meetings.
• Conducts chart review on assessments to ensure compliance with contractual requirements
• Provides comprehensive documentation of all activities and contacts in NHPRI software systems
• Facilitates initial referrals and coordinates needed services
• Collaborates with team as necessary in identifying initial services and supports
• Meets department and regulatory standards for accuracy, proficiency and documentation in order to communicate decisions and plan of care in an appropriate and timely manner
• Serves as a clinical resource to respond to questions from various departments
• Provides cross-coverage as needed
• Participates in outreach, community and marketing activities as needed and as appropriate
• Provides clinical support to members, providers and care givers via video conferencing technologies when clinically appropriate for providing care
• Actively participates in activities and education to maintain and advance clinical competencies
• Other duties as assigned
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Qualifications

Required:

• Registered Nurse with an active, current, unrestricted license in RI in good standing (Consideration will be given to individuals without current RI license. Must provide documentation confirming RI RN application within 24 hours of offer) OR
• Masters degree with active, current, unrestricted LICSW or LCSW license in RI in good standing
• Minimum of three (3) years care management, acute care or community health nursing experience
• Demonstrated experience working with Medicare/Medicaid (MMP), Medicaid, Medicare or commercial products
• PC based software programs - intermediate level of proficiency
• Strong organizational and interpersonal skills
• Customer service orientation
• Ability to work independently and prioritize activities
• Must have access to reliable transportation. If using personal vehicle, must have active drivers license and auto insurance

Preferred:

• Managed Care experience
• BSN or Certification as a CM
• Clinical specialty experience
• Bilingual