The Care Manager assists members appropriate for care coordination and case management services in achieving their optimal level of health. The Care Manager is responsible for engaging the member and providers to assess, plan and establish individual member goals.
Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care coordination program. Assess members to determine care coordination and case management needs for all referred members.
Completes comprehensive assessment of environmental, Psycho-social and support needs. Identifies problems/barriers for care coordination and appropriate care management interventions. Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health.
Identifies both short and long term goals and associated time frames for completion. Shares goals with the member and family as appropriate.Identifies and implements the appropriate level of intervention based upon the member's needs and clinical progress. Schedules follow up calls as necessary, makes appropriate referrals and in-person visits to members when needed.
Implements actions to address member issues. Documents progress towards meeting goals and resolving problems. Coordinates care and services with the Account manager, Complex RN Case Manager, and member, family members as appropriate, PCP, Specialist, and Facility/Vendor Providers.
Responsible for designing and administering programs of Care Coordination (as this is defined in Section C.10.3 and C.1.3.26) and case management for patients with multiple and complex physical, mental, and/or substance abuse conditions and treatment needs. The Manager shall oversee the provision of a range of services and benefits covered under Sections C.8 and C.10 and in accordance with Section C.9 from multiple network Providers, as well as have knowledge of, and the ability to coordinate Covered Services with medical, educational, social, and other services and benefits that are available through other health, educational, and social services available in the District.
A bachelors (or higher) degree in a health related field and licensure as a health professional (where such licensure is available); or
Certification as a case manager (as documented and accepted on URAC's website@ www.urac.org); or
MSW licensure and three (3) years professional practice experience; and
Active state RN, LISW or MD licensure in DC.
Valid driver's license with car insurance.
3-5 years of Case Management preferred.
Located in the District of Columbia (DC), under the leadership of a Manager with an RN, LICSW or MD licensure in the DC.
Amerihealth Caritas Health Plan