The Clinical Case Manager assists members who are eligible for LTSS in obtaining the services they need as required by DSHP Plus LTSS. He or she contributes to the LTSS case management process by performing telephonic and/or face-to-face assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services and long term services and supports. This position is also responsible for completing Level of Care Redeterminations for home and community based members annually. This requires clinical review when evaluating the need for a member to remain in the program. The Clinical Case Manager will also provide clinical support to his/her non-licensed counterparts and may act as a secondary case manager when a member is experiencing an acute episode.
Key Accountabilities and Responsibilities
Conducts reevaluation of level of care annually or more frequently as needed in accordance with DSHP Plan plus LTSS requirements.
Provides clinical support to non-licensed case managers as needed.
Conduct condition specific assessments with members with chronic conditions. Provide education and routine follow-up with member.
Perform initial clinical assessment of new members, develop care plan, and initiate services.
Facilitate person-centered planning team meetings to coordinate care and services. Identify, coordinate, and assist participants in gaining access to needed LTSS and other Covered Services, as well as non-covered medical, social, housing, educational, and other services and supports.
Provides information to participants and conducts monitoring of authorized services and supports for Participants.
Informs participants about available LTSS required needs assessments, the care plan process, service alternatives and service delivery options.
Informs participants of their rights and responsibilities as well as assists with the complaint, grievance, and DHS Fair Hearing process.
Collects additional necessary information, including participant preferences, strengths, and goals to inform the development of the Plan of Care.
Conducts comprehensive needs assessments annually or more frequently as needed in accordance with requirements.
Review and acting upon worklists in Jiva, including monitoring of new members
Authorize urgent services when needed
Monitoring critical incident reporting/documentation, recommending/taking action w/ other corporate entities as required
Liaison activities with Physical health Care Coordination program
Delaware licensed RN or LCSW.
Valid driver's license required.
At least three years working in social service or health care related field.
Experience working with people with disabilities or seniors in need of LTSS.
Knowledge of the home and community-based service system and how to access and arrange for services;
Experience conducting LTSS needs assessments and monitoring LTSS delivery.
Ability to provide informed advocacy.
Ability to interact with health care professionals in a professional manner.
Ability to travel up to 75%
Amerihealth Caritas Health Plan