Oversees the care for long term support services / long term care populations and provides coordination of care services for lower acuity individuals living in the community or nursing facilities.
Ensures a comprehensive assessment of member's care needs and status, interdisciplinary team approach, and education of members.
Works closely with internal and external partners to achieve optimal health care outcomes for the member through effective coordination of care activities.
This role also acts as a SME for the department in representing management in meetings, training new staff, integrating new case management initiatives in conjunction with management and establishes and revises better best practice within the department.
Coordination and care management of members with lower utilization of home community services (i.e. members attending adult day care services or those who are stable on current medication / treatment regimens).
Manages an active caseload based on state mandated ratios according to residential setting, case intensity and acuity.
Ensures comprehensive assessments are completed within required time frames and utilizes knowledge and expertise to assess options for care including use of benefits and community resources.
Partners effectively with the PCP, Specialist, member, member's family and integrated care teams (ICT) to develop a Person Centered Care Plan.
In partnership with the member, family, physician(s), ICT and other providers, assesses short and long term member needs, evaluates the need for alternative services and establishes member driven care management objectives.
Responsible for coordination of service authorizations (i.e. meals, transportation, activities of daily living).
Educates on and coordinates community resources with emphasis on medical, behavioral and social services. Applies care management standards and maintains HIPAA standards and confidentiality of protected health information.
Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
Assists with implementation of new and expanding healthcare case management initiatives.
Assists in implementation of market specific strategies that improve on the quality and outcomes of member's care.
Represents supervisors and management in meetings or on special assignments.
Helps establish process improvements leading to best practice and assist in implementing change movement.
Trains, mentors and provides guidance to new and current Field Service Coordinators regarding policy and procedure, systemic tools, workload and care plan development.
Performs special projects as assigned.Additional Responsibilities:
Education: Bachelor's degree in social work, sociology, psychology, gerontology, or other related social services field and 4+ years of relevant experience OR Master's degree in social work, sociology, psychology, gerontology, or a related social services field, 2+ years of experience obtained through a practicum, internship, or clinical rotation on an equivalent basis and 2+ years of relevant experience OR Equivalent experience of 8+ years. (Florida LTC and Illinois LTSS)
If RN, 2 years of experience is required
Licenses and Certifications: CPR Certified required (Florida Only). Licensed Behavioral Professional i.e. RN, LPN, LCSW, LMHC, LMFT, LPC, LMST, LCPC required (Illinois Only)
Certified Case Manager (CCM), other Licensed Behavioral Professional i.e. RN, LPN, LCSW, LMHC, LMFT, LPC, LMST preferred.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Posting ID: 582341122Posted: 2020-10-26