Case Manager - RN/LPN/Social Worker

Care Ally, Case Manager

The Care Ally, Case Manager is a key member of the interdisciplinary care team (ICT). They use a collaborative process of assessment, planning, implementing, coordinating, monitoring, and evaluating options and services required to meet the members health and social needs. They act as a liaison between our Members, their Responsible Parties and/or Power of Attorneys (RP/POAs), Advance Plan Provider/PCP, and key Align Senior Care stakeholders. The Care Ally, Case Manager reports to the Supervisor of Case Management.

Essential Duties & Responsibilities:

• Executes on strategies and goals set by the Align Senior Care Board of Directors, the Senior Leadership Team, and Executive Director for managing and improving overall Member experience.
• Contacts Plan members to conduct a comprehensive health assessment of the individual, develop a plan of care, and participate in the facilities interdisciplinary care team meeting.
• Serves as health coach to educate the member, the family and/or caregiver, about disease status and treatment, plan benefits, community resources, and resource options.
• Collaborate with members of the interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members.
• Routinely follows up with member as scheduled to assess progress towards goals.
• Communicate with the member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals.
• Provide patient-centered intervention, such as making and verifying appointments, performing medication and care compliance initiatives.
• Acts as front-line support with Members and their RP/POAs to ensure the needs of the Member are met. Serves as a connection point among Members, their Communities, their Care Team, and Align Senior Care internal departments.
• Regularly engages Align Senior Care Members and RP/POAs in-person or by phone to provide education and assistance with utilizing Align Senior Care benefits. Including but not limited to. checking on upcoming specialist appointments, connecting members to supplemental benefits and providers, identifying immediate Member needs, and answering any questions the Member or RP/POA may have.
• Communicates Member health updates from Care Team to RP/POAs.
• Coordinates with the Care Team for non-urgent health or clinical questions.
• Works directly with internal departments to solve Member Grievances, Utilization Management, and Billing related issues.
• Updates Member and RP/POA contact information such as changes of address, email, or phone numbers.
• Actively supports Account Manager in identifying and securing contracts with "preferred" Providers.
• Assists Members, RP/POAs, and Partner Communities with locating in-network providers and scheduling/facilitation of appointments.
• Assists with (on request of member or APP) coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members.
• Monitors and, if needed, facilitates care team meetings with facility team, member, responsible parties(s) and the APP/clinical team.
• Ensure documentation of care team meetings and transmits to Plan.
• Monitors care plan updates, facilitates APP and PCP input into care plan, and distributes care plan as needed to care team members.
• Monitors midnight reports/community census to help identify member transitions to hospital or other care levels.

Qualifications:

• Ability to work autonomously in a hybrid role, independently manage and schedule field visits, complete documentation, meet deadlines, and follow up consistently.
• Candidates must have access to reliable transportation and be comfortable traveling to assigned facilities an average of 2 to 3 days per week, with the remaining time spent working from a home office.

Education and Experience:

• One (1) year of clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, or concurrent review.
• Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.
• Case management certification preferred.
• Long-term care or nursing facility experience preferred.
• Case management certification preferred.

Professional Certification or Licensure:

• Candidates must meet one of the following:
• Active, unrestricted RN or LPN license in the state where job duties are performed; OR
• Bachelor's degree in social work (BSW). A Master of Social Work (MSW) and social-work licensure are preferred but not required.

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.

*The company is unable to provide sponsorship for a visa at this time (H1B or otherwise).