Care Manager SW; Medicare NY

Position Overview

The primary goal of the Care Manager is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them. The Care Manager is expected to assess and evaluate members’ needs, and be a creative, efficient, and resourceful problem solver.

The Care Manager is monitored and assessed based on value added to improved health status of members. That includes, but not limited to their disease management physical and behavioral, medication adherence, and utilization of emergency services, hospitalizations, and avoidable complications. The Care Manager’s primary role is to support members in need and problem solve issues in a beneficial manner for the member and Plan.

The support is comprehensive and includes clinical, social, financial, environmental and safety aspects.

• Physically meet the members where they are to gain deep understanding of their situation and needs
• Problem solves member’s problems and needs: clinical, psychosocial, financial, environmental
• Provide services to members of varying age, clinical scenario, culture, financial means, social support, and motivation
• Engage members in a collaborative relationship, empowering them to manage their physical, psychosocial and environmental health to improve and maintain lifelong well being
• Assess risks and gaps in care
• Maximize member’s access to available resources
• Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
• Communicate plan of care to Primary Care Physician initially and no less than monthly with updates
• Ensure member caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers using verbal and nonverbal techniques
• Train member on relevant chronic diseases, preventive care, medication management (medication adherence), home safety, etc.
• Provide Complex care management including but not limited to; insuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
• Advocate for members by assisting them to address challenges, and make informed choices regarding clinical status and treatment options
• Develop collaborative relationships with clinical providers and facility staff
• Employ critical thinking and judgment when dealing with unplanned issues
• Ability to use data as a tool in tracking and trending outcomes and clinical information
• Maintain accurate, comprehensive, and current clinical and non-clinical documents
• Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures, and actively participate in evaluation process
• Maintain professional competencies as a Care Manager
• Other duties as assigned by Team Lead and Manager.

• Master’s Degree required
• Minimum 3 years’ prior experience in Case Management in a health care and/or Managed Care setting strongly preferred
• Proficiency with computers navigating in multiple systems and web-based applications
• Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
• Ability to travel within the Metro Plus Health  service area making home visits to members, facility visits to clinical providers, and visits to community, faith, and other social service-based agencies
• Ability to work closely with member and caregiver.

• A…