Care Manager

Care Manager

Qualifications for Care Manager

• Perform initial and annual home assessments for Medi-Medi members referred to Care Coordination determine eligibility for Long Term Services and Supports (LTSS).
• Assist Registered Nurse in determining Nursing Facility Level of Care, assess for unmet home and community service needs, as well as needs for complex case management referrals.
• Provide short term care coordination/case management which includes coaching, education, navigation and referrals to community based resources.
• Partner with team members to prepare Service Authorizations, arrange, coordinate, and monitor service for members per department guidelines.
• Complete timely and accurate documentation in multiple computer systems to complete assessment and corresponding documentation: care plans, service plans, authorizations, and progress notes as necessary.
• Follow SNP policy and procedures and ensures all appropriate assessments for this population are completed and acted upon within established timeframes.
• Maintain the member's right to privacy and protects the operations by keeping information confidential.
• Adhere to all quality, compliance and regulatory standards to achieve HCS and the outcomes.

Requirements for Care Manager

• Bachelor's Degree in Social Work, Nursing, Gerontology, or related field
• Must be bilingual English/Spanish
• Ability to actively service areas in and around Palm Springs, Coachella, and Hemet
• 3+ years of experience in managed care or healthcare environment
• Demonstrated knowledge of assessment, health and functional problems of older adults and managed care
• Basic knowledge of related NCQA standards, CMS and DHS regulations
• Excellent organizational, decision-making and multi-tasking skills
• Demonstrated customer focus; proactively finds ways to exceed customer needs
• Demonstrates keen attention to detail and produces high quality work products
• Ability to work well in a fast-paced and dynamic environment
• Proficient in MS Office
• Must maintain valid drivers' license, automobile insurance and have reliable transportation
• Master's Degree in Social Work (MSW) - Preferred
• Medicare/Medicaid experience - Preferred