Care Manager

Care Manager

Job Description:

• Address the needs of the population served by assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required.
• Collaborate with the Primary Care Provider, member, guardian, caregivers, family members, other members of the Care Management Team, and the community to coordinate a full continuum of health care services.
• May work remotely within regions to cover the needs across the state.

Essential Functions:

• Provide effective Care Management services based on case management standards of practice.
• Complete member assessments considering medical, biopsychosocial, behavioral, spiritual, and cultural needs.
• Identify and address behavioral, social, cultural, and environmental strengths and barriers.
• Provide education on clinical diagnosis, medications, available resources, prevention, and risk factors.
• Monitor quality and effectiveness of interventions by setting patient-centered SMART goals.
• Develop, review, implement, and evaluate the member care plan.
• Incorporate therapeutic skills and techniques like trauma-informed care and motivational interviewing.
• Utilize Hospital/Data or Electronic Medical Record system as available.
• Facilitate referrals to appropriate community-based services and agencies.
• Refer to clinical team members for interventions outside the Care Managers' scope.
• Work collaboratively with multi-disciplinary team members.
• Engage and maintain relationships with community provider agencies.
• Serve as a liaison to coordinate services without duplication.
• Respect member's values and empower them to advocate for their own care.
• Maintain appropriate member documentation in accordance with organizational policies.
• Meet monthly productivity and role expectations.
• Adhere to CCNC privacy, security policies, and HIPAA regulations.
• Attend departmental and corporate meetings, training, or other events as required.
• Travel using personal vehicle will be required within the region and/or the state.

Qualifications:

Registered Nurse (RN):

• Graduation from an accredited school of nursing.
• BSN preferred.
• Active, unrestricted RN license to practice in North Carolina.
• Minimum 2 years' nursing experience; 1-year care management or community-based nursing preferred.
• CCM certification preferred; will obtain within 1 year of eligibility per CCM requirements.
• 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.

OR

Social Worker:

• Master's degree from an accredited school of social work.
• Minimum 2 years' social work experience; 1-year case management or community-based social work preferred.
• Active NC license as a Licensed Clinical Social Worker (LCSW).
• CCM certification preferred; will obtain within 1 year of eligibility per CCM requirements.
• 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.

Knowledge, Skills, and Abilities:

• Computer skills required including various office software; 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 and assessing comprehensive health care needs.
• Critical thinking skills and effective clinical judgment.
• Sensitivity to diversity of cultures, language barriers, health literacy, and educational levels.
• Ability to work independently and as part of a multi-disciplinary team.
• Responds to change with a positive attitude and willingness to learn.

Working Conditions:

• Primarily an office or home environment.
• Multiple face-to-face and/or telephonic contacts required.
• Exposure to general office and household conditions, as well as communicable diseases, may occur.
• Routine physical inconveniences or discomforts in the work setting.
• Must be