Case Manager

POSITION SUMMARY Assesses and determines the level of care and appropriateness of community-based services for prospective Members. Reassesses client needs in response to condition changes or requests from service providers or other case management team members, and relays information to physicians and other health care partners. MINIMUM JOB REQUIREMENTS Education Qualifications: Education: Graduate of an accredited Diploma, Associate Degree or Baccalaureate School of Nursing. Preference is given to individuals with Baccalaureate Degree. Licensure/Certifications: Must have current and valid licensure by the Georgia State Board of Nursing. Current CPR certification required. Current CPR certification required Previous Experience: 2 years experience as a registered professional nurse in the area of home health, hospice, community health, long-term care or geriatric nursing. Experience in long term care preferred Knowledge/Training: Knowledge of Medicare, Medicaid and other funding source regulations as applied to service program. Demonstrates knowledge and competence in advanced practice nursing skills, including the nursing process and collaborating with interdisciplinary team Skills: Must be able to function independently and efficiently in community-based environment. Requires proven interpersonal skills with an ability to communicate effectively. Demonstrates proven decision skills, organizational, self-discipline, and time management skills. Must be skilled in physical assessment and development of care plans. Computer Skills: Must be familiar with general use and functions of the computer, such as, user names and password concepts; internet; e-mail; navigation of computer desktop or laptop, including starting programs, using files, and windows, effectively use navigation buttons and tool bars; ability to self-manage online HR services and online training programs. Transportation: Must have reliable transportation. Job Duties: * Maintains current knowledge of community resources in order to ensure that the care plan is realistic and to coordinate and/or arrange services to clients. * Serves as the transition point and link between the assessment process and the effective delivery of direct services. * Develops appropriate care plans in consultation with the client, client s family and service providers. * Implements the care plan and arranges services. * Arranges Title III and other applicable community-based services in collaboration with the client and family members. * Monitors service delivery to individual clients. Follows-up on each direct service to determine if it is being provided as appropriate and is effectively meeting the client s needs. * Complies with standards of promptness set forth by DHR policy regarding specific activities: Completes assessments within 3 days of slot availability, follows up on direct services ordered within 10 days, reviews care plan within the prescribed time frame according to client s level of need, gives a monthly report to the Team Leader, completes a reassessment annually. * Arranges emergency services as applicable * Coordinates with the lead agency to assure that all components of the program are responsive to the needs of the client. * Maintains current knowledge about the service standards for each service. Documentation: * Documents care activity and service information. * Ensures that documentation is consistent with the format required by departmental standards (i.e. progress notes reflect care plans.) * Maintains confidential case records on all clients. * Completes necessary forms, applications, documents in a timely manner that are required by outside agencies. * Demonstrates the ability to follow through in a thorough and timely manner on tasks assigned by management team and requests made by patients/families, referral sources, and community. Financial: * Limits amount and frequency of service in order to assure that costs do not exceed the limitations established by the Division of Aging Services and Dekalb County Government. * Discusses and completes the Income Determination Worksheet with clients, encouraging client cost share wherever financially possible. Regulatory: * Demonstrates knowledge and understanding of the Program manual, Medicare and Medicaid manuals, physician's orders and the standards of care: