Care Manager GUILFORD COUNTY

Position Summary

Address the needs of the population served by assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required and using communication and available resources to promote quality, cost-effective health outcomes.

Work within the Registered Nurse and/or Social Work scope of practice, and in concert with the Primary Care Provider, member, caregivers, family members, other members of the Care Management Team and the community to coordinate a full continuum of health care services considering the holistic needs of the member, inclusive of unique social and cultural dynamics. The Care Manager 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 to enrolled populations
• Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual and cultural needs to enrolled population, throughout the continuum of care
• Develop, review, and evaluate the member care plan in partnership with the member, caregiver/family members, providers, and Care Management team members, as applicable
• Work with members to identify behavioral, social, cultural, and environmental strengths and challenges as it relates to his/her diagnosis, treatment, and access to care.
• Identify and address barriers that impede health outcomes
• Implement Care Management interventions per the member’s care plan
• Work in conjunction with member to formulate, develop, and implement member-centered plans using therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities.
• Provide education to member/family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management
• Utilize therapeutic skills and techniques to help members achieve healing, growth, health, and wellness
• Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members/families
• Access to Hospital/Data or Electronic Medical Record system will be required, as necessary
• Facilitate referrals for members/families to appropriate community-based services and agencies
• Refer members to other appropriate clinical team members for interventions which are outside the Care Managers’ scope of practice and/or expertise
• Serve as a liaison among the member/family, community services, primary providers, specialists, and other care team members to coordinate services without duplication
• Respect member’s values and experience and help to empower members to be an advocate for their own care.
• Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes
• Maintain appropriate member documentation in the Care Management documentation platform, in accordance with organizational policies and procedures
• Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization

• Adhere to CCNC privacy and security policies to ensure that patient and company data are properly safeguarded

• Abide by department guidelines, company policies, and HIPAA regulations.
• Perform other duties that assist in keeping the operation organized and functional.
• Attend departmental and corporate meetings, local and regional trainings, or other events as required
• Understand and uphold CCNC goals, objectives, and standards.
• 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
• Meets licensure or educational eligibility requirements as determined by The Commission for Case Management Certification
• 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

• 
  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) or LCSWA with completion of LCSW within 2 years of hire
• CCM certification preferred; will obtain within 1 year of eligibility per CCM requirements.
• Meets licensure or educational eligibility requirements as determined by The Commission for Case Management Certification
• 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

• 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
• Computer skills required including various office software and the internet; experience with MS Office software preferred
• Skills in establishing rapport with a member and applying techniques of assessing comprehensive health care needs
• Critical thinking skills, effective clinical judgment, independent decision-making, and problem-solving abilities
• Sensitivity to diversity of cultures, language barriers, health literacy and educational levels
• Ability to work independently and function as an integral part of a multi-disciplinary team
• Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives
• Able to shift strategy or approach in response to the demands of a situation

Working Conditions

• The job environment is primarily an office or home environment.
• Multiple contacts, face to face and/or telephonic, are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur
• Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time
• Must be able to utilize office equipment, computer, keyboard and phone with or without assistive devices
• Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds.
• Travel will be required within the region and/or the State