Job Profile Summary
Position Purpose:
Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.
Education/Experience:
Requires a Bachelor's degree and 2 – 4 years of related experience.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
License/Certification:
For Iowa Only: Bachelor's degree with 30 semester hours or equivalent quarter hours in a human services field (including, but not limited to, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy) and at least two years of experience in the delivery of services to the population groups or current state's Registered Nurse (RN) license and at least four years of experience required
For North Carolina Standard Plan: Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience; Prior experience with social work, geriatrics, gerontology, pediatrics, or human services.
RN or LCSW required.
For North Carolina Tailored Plan: Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience; Prior experience with social work, geriatrics, gerontology, pediatrics, or human services.
RN or LCSW / LCSW-A preferred
For Arkansas Total Care plan - This position is designated as safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment check (before hire and recurring), and a drug screen (at time of hire and recurring). Must reside in AR or border city. Travel: 5%. required
Responsibilities
Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome
Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members
Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans
Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs
Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met
Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners
Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits
Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
Performs other duties as assigned
Complies with all policies and standards
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
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Position Purpose:
Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. Will develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.
Member facing but potentially provider facing
Story Behind the Need
- What is the purpose of this team?
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
Additional staff needed due to business fluctuation
Virtual team meetings – CAMERAS ON
Typical Day in the Role
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
Day to Day Responsibilities of this Position and Description of Project:
Managing a case load for healthcare members with LTSS (Long Term Support/Services) needs.
Monthly and quarterly member contact and will include 80% travel. Remote role. Will require a driver’s license.
Member assessments and notes.
Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development.
Monitor delivery of services and follow-up with members, caregivers, or provider s through in person visits and telephonic contact
Authorize and coordinate referral for services.
Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care.
Assist in coordinating the development of informal or voluntary services to integrate into the member care plan Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long-term care services!
Assist member with filing and resolving complaints and appeals.
Licensed Clinical Social Worker/Registered Nurse License and 2+ years of physical health care management experience, 4-6+ years of physical health care management experience preferred. Hospital CM, Home health, discharge planning, or long-term care experience preferred. Licenses/Certifications: Valid driver's license
Candidate Requirements
Education/Certification
Required: Bachelor’s
Preferred:
Licensure
Required: RN and/or LCSW/LCSW-A/BSN/ADN
Preferred:
Years of experience required: 2-4+ years of physical health care management experience, 4-6+ years of physical health care management experience preferred. Hospital CM, Home health, discharge planning, or long-term care experience preferred. Case management and care planning experience.
Preferred - Home health experience , community health/member facing, discharge planning
Disqualifiers: No Psych experience such as counseling (must have bedside case management hospital physical as well) no Right out of nursing school. No Nursing homes. No rehab.
Additional qualities to look for: Virtual, All Microsoft office, Experience with electronic medical health records
- Top 3 must-have hard skills stack-ranked by importance
1
Physical hospital Health, Care Management, Utilization Mgt, Home Health – all and/or background
2
Microsoft office – Tech savvy
3
Bedside care management
Candidate Review & Selection
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Projected Manager Candidate Review Date:
1-2 days post shortlisting
Type of Interviews:
Teams CAMERA ON
Required Testing or Assessment (by Vendor):
NA
