Care Manager

Job Location

Hoke Center - Raeford, NC 28376

$23.08 - $24.04 per hour

• Medical, Dental and Vision Insurance
• Health Spending Account
• Company-Paid Life Insurance
• Short Term Disability
• 401(k)
• Paid Holidays
• Paid Vacation and Sick Leave
• Employee Assistant Program
• Referral Bonus Opportunities
• Extensive Internal Training Program

Under direct and indirect supervision, provides case management assessment, person‑centered planning and documentation, referral and linkage, and monitoring/follow‑up.

• Provide care management assessment/reassessment, develop care plans, refer and link to needed services, monitor/follow up with clients and referrals, provide health promotion education, and ensure metrics for outcomes are met.
• Participate in interdisciplinary treatment planning, and consultation activities, ensuring all involved parties are aware of the plan of care.
• Provide crisis intervention consultation to all participants of TCM and involve crisis services when needed.
• Perform all other duties as assigned by supervisor.

• Document the client’s service needs, strengths, resources, preferences, and goals to develop a Care Management Plan.
• Gather information regarding all aspects of the recipient, including medical, physical, psychosocial, behavioral, financial, social, cultural, environmental, legal, and vocational/educational areas.
• Integrate all current assessments, including the comprehensive clinical assessment and medical assessments, and information from the HIE/Tailored Plan and the primary care or specialty care physician.
• Identify early conditions and needs for prevention and amelioration.
• Consult with other natural and paid supports such as family members, medical and behavioral health providers, and educators.
• Perform periodic reassessment to determine whether a recipient’s needs or preferences have changed.

• Ensure person‑centered information is gathered and that the consumer’s health and safety risks are assessed prior to developing the care plan.
• Work in conjunction with the client, family, friends, and providers who have experience with the person.
• Perform periodic revision of the plan based on information collected.
• Assist the person to obtain the desired outcomes/skills/symptom reduction.
• Contact the primary care physician to obtain clinical information necessary for goals.
• Facilitate provider choice process, maintain objectivity, and provide fact‑finding assistance.
• Ensure signed Authorization to Disclose Health Information forms are obtained and on file before releasing information.
• Document released information on the Accounting of Release and Disclosure form.

• Coordinating the delivery of services to reduce fragmentation of care and maximize mutually agreed outcomes.
• Facilitate access to and connect recipients to services and supports identified in the Plan.
• Make referrals to providers, schedule appointments, and assist the recipient during transitions through levels of care.
• Facilitate communication and collaboration among all service providers and the recipient.
• Assist recipient in establishing and maintaining a medical home and in establishing OBGYN and prenatal care when needed.

• Assist consumer and legally responsible person in accessing natural community supports such as educational services, transportation, support from friends/family/church, etc.
• Coordinate paid supports/services with other available community resources to ensure best possible treatment and care.

• Ensure services are provided in accordance with the Care Management Plan.
• Confirm that the services in the plan are adequate and…