Clinical - LTSS Service Care Manager

Job Title: ClinicalLTSS Care ManagerLocation: Guilford County, NCPay: Competitive salary based on experienceResponsibilitiesAssists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes.May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome.Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialists, and/or community resources needed for long-term care.Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members.Provides resource support to members and their families/caregivers for various needs (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans.Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs.Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met.Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.May perform home and/or other site visits to assess member's needs and collaborate with healthcare providers and partners.Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits.Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.Performs other duties as assigned.Complies with all policies and standards.Typical Day in the RoleManaging a case load for healthcare members with LTSS (Long Term Support/Services) needs.Monthly and quarterly member contact and will include 80% travel. Remote role. Will require a driver's license.Member assessments and notes.Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development.Monitor delivery of services and follow-up with members, caregivers, or providers through in-person visits and telephonic contact.Authorize and coordinate referral for services.Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care.Assist in coordinating the development of informal or voluntary services to integrate into the member care plan.Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long-term care services.Assist member with filing and resolving complaints and appeals.Candidate RequirementsEducation/Certification: Required: Bachelor'sLicensure: Required: RNYears of experience required: 2-4 years of physical health care management experience, 4-6 years of physical health care management experience preferred. Hospital CM, Home health, discharge planning, or long-term care experience preferred.Disqualifiers: No Psych experience such as counseling (must have bedside case management hospital physical as well) no Right out of nursing school. No Nursing homes. No rehab.Additional qualities to look for: Virtual, All Microsoft office, Experience with electronic medical health records.Top 3 must-have hard skills stack-ranked by importance:RN and/or LCSW Physical hospital Health, Care Management, Utilization Mgt, Home Health - all and/or backgroundMicrosoft officeBedside care managementSeniority LevelMid-Senior levelEmployment TypeContractJob FunctionHealth Care ProviderIndustriesStaffing and Recruiting#J-18808-Ljbffr