Case Manager(RN)

9286
Case Manager(RN)
Health Care
Miami
Florida

Under the general supervision of the Director of Health Services, the position is responsible for the ongoing assessment, planning, and evaluation of members within the care management program. The incumbent acts as a liaison between patient/family and healthcare personnel to ensure that the necessary care is provided promptly and effectively.

The Case Manager will be accountable for understanding all aspects of the Leon Health Care Management Program.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

· Oversee clinical, non-clinical and administrative staff

· Responsible for MOC activities, including HRA, individualized care plan, interdisciplinary care team and care transitions

· Manage D-SNP members, in particular those belonging to the most vulnerable population

· Identify needs and create a care plan, with the input of the member’s interdisciplinary care team, to help the member achieve their goals

· Completes assessments with member/caregiver/provider to obtain information regarding client status, functional, cognitive capabilities, support system and need for services

· Support ongoing member engagement

· Address the member’s individual needs, strengths, preferences, and goals

· Educate members on their conditions and promote self-management skills including the understanding signs and symptoms that indicate a need to contact the PCP, and when it is appropriate to seek urgent or emergent care

· Support medication adherence

· Engage in member-centric discharge planning

· Ensure timely initiation of post-discharge services and care

· Link members to available community supports

· Coordinate with the behavioral health case managers and providers

· Communicate and coordinate with the member and their caregivers, practitioners, behavioral health providers, disease management staff, and other members of the ICT to ensure that the member’s needs are addressed, and care transitions are communicated

· Review and coordinate member cases with Medical Director(s) and Behavior Health Practitioner(s)

· Supports standards that are consistent community and nationally recognized evidence-based practice

· Works collaboratively with leaders of Utilization Management to quickly and efficiently address any Care Management or Utilization Management concerns or barriers

· Escalates operational and/or financial concerns as appropriate

· Identifies process improvement opportunities and develops, implements and monitors action plans based upon identified Care Management metrics

· Works in partnership with plan compliance and clinical oversight to support Medicare and Medicaid (if appropriate) grievance and appeals processes.

· Participates in Quality Improvement and Risk Management activities as requested.

· Participates in training and in-service education as required.

· Complies with Leon Health’s policies and procedures and maintains confidentiality of patient’s medical records in accordance with state and federal laws.