Care Ally, Social Worker (63555)

Curana Health is a provider of value-based primary care services exclusively for the senior living industry, including in nursing homes, assisted/independent living facilities, CCRC/life plan communities and affordable senior housing communities. Curana Health serves more than 1,100 senior living community partners across 30 states and participates in both the MSSP ACO, ACO Reach and Medicare Advantage programs with CMS. Backed by more than $300M in venture capital funding, the organization is poised to disrupt care delivery in senior living on a meaningful scale through innovative care models and applied analytics.

Summary

The Care Ally, Case Manager is a key member of the interdisciplinary care team (ICT). They use a collaborative process of assessment, planning, implementing, coordinating, monitoring, and evaluating options and services required to meet the Members health and social needs. They act as a liaison between Members, their Responsible Parties and/or Power of Attorneys (RP/POAs), Advance Practice Providers (APP) and/or Primary Care Physicians (PCP), and other key Align Senior Care stakeholders. The Care Ally, Case Manager reports to the Supervisor of Case Management.

Responsibilities

• Executes strategies and goals set by the Align Senior Care Board of Directors, the Senior Leadership Team, and the Executive Director for managing and improving overall Member experience.

• Contacts Plan Members to conduct a health risk assessment, develop a plan of care, and participate in the Senior Housing Community interdisciplinary care team meeting.

• Conducts face-to-face Member and/or caregiver visits a minimum of quarterly if the Member is in a Long-term Care Facility and twice a year for all other Members.

• Serves as a health coach to educate the Member, the family and/or caregiver, about 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.

• Communicates with the Member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals.

• 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.

• Assists with coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members.

• 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.

Education & Experience

• Undergraduate or graduate degree in social work (LSW)

• 3-5 years of Case Management experience preferred

• Medicare or Medicaid knowledge preferred

• NCQA or URAC experience preferred

• Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.