Serve members (frail elderly, adults with physical disabilities, and adults with intellectual/developmental disabilities) as part of an interdisciplinary team with an RN Care Manager
Provide care management and service coordination to Lakeland Care members
Arrange for provision of services and supports based on a comprehensive assessment of the member's identified outcomes and needs
Monitor provision of services based on the member-centered plan per LCI policy and Department of Health Services (DHS) contract requirements
Coordinate and participate in home visits and care conferences involving the member, their supports, and providers
Collaborate with RN Care Manager to coordinate acute and primary care services, care transitions, and related follow-up care
Conduct in-person comprehensive, strengths-based assessments and perform reassessments as condition changes
Develop, coordinate, monitor and evaluate outcome-based member-centered plans, considering cost and effectiveness in authorizing services and choosing providers
Implement risk mitigation strategies to promote member health, safety and independence while respecting rights to appeal and grieve
Maintain member records as required by DHS contract and LCI policy
Build and maintain effective collaborative working relationships with RN Care Manager partner and various departments/stakeholders
Participate in team meetings and on-going trainings to stay abreast of policies, procedures, and state/federal regulations
Maintain confidentiality of member information and PHI in accordance with HIPAA and state/federal regulations
Requirements
Certified Social Worker in the State of Wisconsin with a minimum of one (1) year experience working with at least one of the family care target populations
A four-year bachelor’s degree or more advanced degree in Human Services or related field with one (1) year experience working with at least one of the family care target populations
A four-year bachelor’s degree or more advanced degree in any other area than Human Services with a minimum of three (3) years’ experience working with at least one of the family care target populations
Working knowledge of computers, computer programs, typing, and data entry
Ability to access members’ homes which are not required to comply with the ADA regulations
Ability to multi-task and work in a fast-paced environment
Ability to lift up to 25lbs
Current driver’s license, acceptable driving record and proof of adequate insurance
Position requires traveling in the field/community visiting members
Maintain the confidentiality of member information and protected health information (PHI) in accordance with HIPAA and state/federal regulations