Case Manager

Responsibilities:

•   Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to achieve optimal clinical and resource outcomes. 

•   Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate intervention and/or discharge planning.

•   Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs; identify barriers to meeting goals or plan of care 

•   Utilize community resources and funding sources as needed in the development of the plan of care.

•   Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.

•   Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc).

•   Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes 

•   Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome. 

•   May outreach directly to members identified as high risk, high cost, or high utilization cases.

•   May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.

•   May evaluate medical necessity and appropriateness of services as defined by department.

•   As needed, develop relevant policies/procedures, education or training for use both internally and externally.

Requirements:

•   RN, RD or LCSW with 3 years of clinical and/or case management experience required. For some roles a Master's in Social Work with 5 years of related experience may be considered.

•   For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.

•   Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.

•   For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification within 2 years of employment.