Case Manager, RN, LPN, Social Worker
Curana Health
full-time
Posted on:
Location Type: Hybrid
Location: Grand Rapids • Missouri • United States
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Job Level
About the role
- Executes on strategies and goals set by the Align Senior Care Board of Directors, the Senior Leadership Team, and Executive Director for managing and improving overall Member experience.
- Contacts Plan members to conduct a comprehensive health assessment of the individual, develop a plan of care, and participate in the facilities interdisciplinary care team meeting.
- Serves as health coach to educate the member, the family and/or caregiver, about disease status and treatment, plan benefits, community resources, and resource options.
- Collaborates with members of the interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members.
- Routinely follows up with member as scheduled to assess progress towards goals.
- Communicates with the member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals.
- Provide patient-centered intervention, such as making and verifying appointments, performing medication and care compliance initiatives.
- Acts as front-line support with Members and their RP/POAs to ensure the needs of the Member are met.
- Serves as a connection point among Members, their Communities, their Care Team, and Align Senior Care internal departments.
- Regularly engages Align Senior Care Members and RP/POAs in-person or by phone to provide education and assistance with utilizing Align Senior Care benefits.
- Including but not limited to. checking on upcoming specialist appointments, connecting members to supplemental benefits and providers, identifying immediate Member needs, and answering any questions the Member or RP/POA may have.
- Communicates Member health updates from Care Team to RP/POAs.
- Coordinates with the Care Team for non-urgent health or clinical questions.
- Works directly with internal departments to solve Member Grievances, Utilization Management, and Billing related issues.
- Updates Member and RP/POA contact information such as changes of address, email, or phone numbers.
- Actively supports Account Manager in identifying and securing contracts with "preferred" Providers.
- Assists Members, RP/POAs, and Partner Communities with locating in-network providers and scheduling/facilitation of appointments.
- Assists with (on request of member or APP) coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members.
- Monitors and, if needed, facilitates care team meetings with facility team, member, responsible partie(s) and the APP/clinical team.
- Ensures documentation of care team meetings and transmits to Plan.
- Monitors care plan updates, facilitates APP and PCP input into care plan, and distributes care plan as needed to care team members.
- Monitors midnight reports/community census to help identify member transitions to hospital or other care levels.
Requirements
- One (1) year of clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.
- Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.
- Case management certification preferred.
- Professional Certification Or Licenses Registered nurse license, active and unencumbered state license in the state where job duties are performed is required.
- BSN preferred OR Active Licensed Social Worker (LSW).
- Bachelor's degree in social work (BSW) required.
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementhome healthcritical caremedical/surgicaldischarge planningconcurrent reviewobstetric careneonatal carepatient-centered interventioncare plan management
Soft Skills
communicationcollaborationhealth coachingproblem-solvinginterpersonal skillsorganizational skillseducational skillsfollow-upmember advocacyteamwork
Certifications
case management certificationRegistered Nurse licenseLicensed Social Worker (LSW)Bachelor's degree in social work (BSW)Bachelor of Science in Nursing (BSN)