Care Manager II

Role Overview:

The Care Manager (RN/SW) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN/SW) engages members, member caregivers, and providers to assess, plan, and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care coordination program. In addition, the Care Manager will oversee these same care management activities within assigned practices to ensure the ACPA delivers high-quality care management services following Plan, NCQA, Federal/State standards and requirements.

Work Arrangement: Fully Remote; must be able to Monday-Friday 8:30am-5:00pm Eastern Time Zone

Responsibilities:

• Assess members through face-to-face encounters and by telephone to determine care coordination and care management needs for all referred members.

• Completes comprehensive person-centered assessment, inclusive of physical health history, mental health history, social determinants of health, and supportive needsCoordinates physical, behavioral health, and social services.

• Provides medication management, including regular medication reconciliation and support of medication adherence.

• Identifies problems/barriers for care coordination and appropriate care management interventions.

• Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health. Identifies goals and assigns priority with associated time frames for completion. Shares goals with the member and family as appropriate.

• Identifies and implements the appropriate level of intervention based upon the member's needs and clinical progress.

• Schedules follow-up calls as necessary and makes appropriate referrals. Implements actions to address member issues.

• Documents progress towards meeting goals and resolving problems within EMR system.

• Coordinates care and services with the Community Health Navigator and member, member caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers.

• Provides transitional care management. Meets regularly with designated partners regarding plan-identified members for care management, assists with reducing/resolving problems and or barriers so that the ACDE Care Coordinator may provide members with high-quality care management services.

• Participate in regularly scheduled meetings as needed.

Education/Experience:

• Minimum of 3 to 5 years experience with the physical health population required.

• Experience working with individuals with Medicaid and Medicare populations preferred

• Ability to work with specific care teams and other engagement community partners preferred.

• Case management experience, preferably within a managed care organization, is desired.

• Proficient with various technologies including Microsoft Tools and Medical Record systems.

• Bilingual (Spanish speaking) preferred

Licensure:

• Current, unrestricted RN license in good standing or unrestricted LMSW / LCSW license with experience in managing medical complexities.

Skills & Abilities:

• Demonstrate ability to be self-directed, independent, adaptive, flexible to change, and able to collaborate as a team member in a fast-paced, ever-changing environment.

• Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.

• Proficiency using MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record and documentation programs.

• Demonstrate strong organizational and time management skills with the ability to promptly prioritize and follow through on multiple items.

• Demonstrate knowledge and experience in assessing members' situations, developing a care plan, and teaching self-management

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.