Salary
💰 $61,500 - $98,400 per year
About the role
- Manage and coordinate services for individuals who require long-term care support and are eligible for community-based waiver programs.
- Engage with member in a variety of community-based settings to establish an effective, care coordination relationship.
- Conduct comprehensive assessments to determine the needs of members eligible for community-based waiver services.
- Develop individualized service plans that outline the necessary supports and services aligned with the individual’s preferences and goals.
- Serve as the primary point of contact for members and their families, coordinating care across multiple providers and services.
- Facilitate access to necessary services such as home health care, personal care assistance, transportation, and other community-based supports.
- Regularly monitor the implementation of service plans and conduct follow-up assessments to evaluate effectiveness and adjust person-centered care plans as needed.
- Advocate for the rights and needs of members receiving waiver services and empower members and their families/caregivers to make informed decisions.
- Build and maintain relationships with healthcare providers, community organizations, and other stakeholders to facilitate integrated care.
- Lead and collaborate with interdisciplinary care team (ICT) to discuss individual cases, coordinate care strategies, and create holistic care plans.
- Provide education and resources to members and their families/caregivers about available services, benefits, and community resources.
- Maintain accurate and up-to-date records of member interactions, care/service plans, and progress notes; assist in preparation of reports and documentation for compliance.
- Respond to crises or emergencies involving members, coordinating immediate interventions and support as needed.
- Evaluate member satisfaction through open communication and monitoring of concerns or issues.
- Regular travel to conduct member, provider and community-based visits as needed and per the regulatory requirements of the program.
- Report abuse, neglect, or exploitation of older adults as a mandated reporter as required by State law.
- Regularly verify and collaborate with Job and Family Service to establish and/or maintain Medicaid eligibility.
- Perform any other job duties as requested.
Requirements
- Nursing degree from an accredited nursing program or Bachelor’s degree in health care field or equivalent years of relevant work experience is required.
- Minimum of 1 year paid clinical experience in home and community-based services is required.
- Medicaid and/or Medicare managed care experience is preferred.
- Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel.
- Prior experience in care coordination, case management, or working with dual-eligible populations is highly beneficial.
- Understanding of Medicare and Medicaid programs, as well community resources and services available to dual-eligible beneficiaries.
- Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers.
- Awareness of and sensitivity to the diverse backgrounds and needs of the populations served.
- Ability to manage multiple cases and priorities while maintaining attention to detail.
- Adhere to code of ethics that aligns with professional practice, including maintaining confidentiality.
- Decision making and problem-solving skills.
- Knowledge of local resources for older adults and persons with disabilities.
- Current and unrestricted license as a Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW) in the State assigned is required.
- Case Management Certification is highly preferred.
- Must have valid driver’s license, vehicle and verifiable insurance. Employment conditional pending clearance of driver’s license record check and verified insurance.
- Employment in this position is conditional pending successful clearance of a criminal background check.
- Influenza vaccination is a requirement of this position; employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
- Must reside in the same territory they are assigned to work in; may be required to travel greater than 50% of time.
- On-call responsibilities as assigned.