Care Manager

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.
• Work with members to identify and address behavioral, social, cultural, and environmental strengths and barriers as it relates to his/her diagnosis, treatment, and access to care.
• Provide education to member/family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management.
• Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members/families.
• Develop, review, implement, and evaluate the member care plan in partnership with the member, caregiver/guardian/family members, providers, and Care Management team members, as applicable.
• Incorporate therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities to help members achieve healing, growth, health, and wellness.
• Utilize Hospital/Data or Electronic Medical Record system as available.
• Per guidance, facilitate referrals for members/families to appropriate community-based services and agencies.
• Refer to appropriate clinical team members for interventions which are outside the Care Managers’ scope of practice and/or expertise.
• Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes.
• Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization.
• Serve as a liaison among the member/family/guardian, community services, primary providers, specialists, and other care team members to coordinate services without duplication.
• Respect member’s values, experience, and help to empower members to be an advocate for their own care.
• Maintain appropriate member documentation in the Care Management documentation platform, in accordance with organizational policies and procedures.
• Meet monthly productivity and role expectations.
• Understand, uphold, and abide by CCNC company and department policies, goals, standards, and objectives.
• Adhere to CCNC privacy, security policies, and HIPAA regulations to ensure that patient and company data are properly safeguarded.
• Attend departmental and corporate meetings, local and regional training, or other events as required.
• Travel using personal vehicle will be required within the region and/or the State.
• Perform all other duties as requested.

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) 
• 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

• Computer skills required including various office software and the internet; experience with MS Office software preferred
• 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
• 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