Case Manager

Case Manager Overview The Case Manager role focuses on coordinating care and resources for members to achieve optimal clinical and resource outcomes. Utilize clinical expertise to perform comprehensive assessments and collaborate on treatment plans and interventions. Develop member-centric plans tailored to individual needs, health status, and support requirements. Leverage community resources and funding sources to enhance care plans effectively. Monitor and manage members’ progress, ensuring timely follow-ups and appropriate referrals. Evaluate and facilitate care across various settings, including hospitals, rehabilitation units, and home care. Document all aspects of care plans, from initial assessment to outcome evaluation. Outreach to high-risk or high-cost cases, reviewing alternative treatment plans and assessing benefits. Develop policies, procedures, and training materials to support internal and external stakeholders. Case Manager Key Responsibilities & Duties Coordinate care and resources for members, ensuring optimal clinical outcomes and cost-effectiveness. Perform comprehensive assessments to guide treatment plans and interventions. Develop tailored care plans addressing members’ needs and barriers to achieving goals. Utilize community resources and funding sources to enhance care plans. Monitor member progress, adjusting plans and goals as necessary based on acuity. Educate members on proactive interventions to improve outcomes and reduce expenses. Document all aspects of care plans, ensuring accuracy and completeness. Outreach to high-risk cases, assessing alternative treatment plans and benefits options. Develop policies, procedures, and training materials to support case management practices. Case Manager Job Requirements Bachelor of Science in Nursing (BSN) required; valid clinical license (NC or compact multi-state). Minimum of 3 years of clinical and/or case management experience; 5 years preferred. Specialty certifications such as CCM or CDCES may be required within 2 years. Experience in behavioral health roles with applicable licensure is advantageous. Strong knowledge of community resources and funding sources for care planning. Proficient in developing and documenting comprehensive care plans and interventions. Ability to evaluate medical necessity and appropriateness of services effectively. Skilled in educating members on proactive interventions and positive outcomes. Experience in policy development and training for case management practices. #J-18808-Ljbffr Greenkey Resources LLC