LVN, High Risk Care Manager

The High Risk (Outpatient) Care Manager (HRCM) is responsible for assessment, treatment planning, intervention, monitoring, evaluation, and documentation on identified High Risk members.

The HRCM will assess and develop a care plan in collaboration with the Primary Care Physician, members and other health care practitioners as needed.

The goal of HRCM is to effectively manage members on an outpatient basis to ensure the appropriate level of care is provided, to prevent in patient admission and re-admissions, and ensure that the members’ medical, environmental, and psycho-social needs are met over the continuum of care.

ESSENTIAL DUTIES and RESPONSIBLITIES:

• Function as liaison between administration, members, physicians, and other healthcare providers.
• Interact professionally with members/family/physicians and involves members/family/physicians in formation of the plan of care.
• Performs a Clinical Assessment/Questionnaire of the member and determines an acuity score for necessary scheduled follow-up.
• Develops an outcome-based plan of care, based on the member’s input and assessed member needs.
• Implements and evaluates the plan of care as often as needed as evidenced by documentation in the members' case file(s).
• Documents member assessment and reassessment, member care plans, and other pertinent information completed in the members’ medical records.
• Identifies planned and unplanned transitions of care from requests for services or daily in-patient and SNF census.
• Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care.
• Manages transition of care from the sending to receiving settings ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member’s health care status changes.
• Communicates appropriately and clearly with physicians, in-patient case managers, and Prior-Authorization team.
• Identifies and addresses pharmacological needs of the members and facilitates consultations with the pharmacy department, as necessary.
• Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker, as necessary.
• Responsible for the coordination of clinic appointments, medication reconciliation, PCP and SPC visits.
• Meet with members/caregiver face to face in various locations (clinic, home, hospital, and community) to build a rapport with members to better support member/caregiver with care coordination and the appropriate plan of care.
• Perform other duties as assigned by management.

ADHERENCE to POLICIES:

• Promote organizational goals.
• Know and follow Employee Handbook and all other company Policies and Procedures Manual(s).
• Communicate respectfully with members, families, co-workers, and all those encountered in workday.
• Communicate verbally and in writing through proper channels.
• Adhere to all Compliance Regulations including, HIPAA, Fraud, Waste, and Abuse, Harassment, Code of Conduct, Model of Care, Cultural and Linguistics, and Injury and Illness.
• Participate in required meetings and follow meeting protocols.
• Follow all company policies and procedures.

COMPLIANCE STATEMENT:

This position requires that the Employee abide by the Company’s Compliance Plan (including its Standards of Conduct) and all Compliance Policies and Procedures (as listed on the Company’s Intranets or Internet pages under Compliance). This position further requires the Employee to act with the highest standards of integrity and professional ethics. This would include but is not limited to the expectation and requirement that the Employee immediately report any potential Compliance, Security or Privacy, or potential Fraud‑Waste‑Abuse violations or issues to the Company’s Compliance Officer, Compliance Hotline,…