Case Manager

Overview

• Collaborate within a multidisciplinary team to coordinate care and resources for optimal clinical outcomes.
• Perform comprehensive assessments to develop tailored plans addressing members' needs and barriers.
• Utilize clinical skills and community resources to support members' health and recovery goals.
• Monitor and manage member progress, modifying plans as needed for effective outcomes.
• Educate members on proactive interventions to reduce costs and improve health outcomes.
• Document all aspects of case management, including assessments, plans, and evaluations.
• Outreach to high-risk members to provide targeted case management and support.
• Develop policies, procedures, and training materials for internal and external use.

Key Responsibilities & Duties

• Coordinate care and resources among internal and external providers for optimal outcomes.
• Conduct detailed assessments to identify member needs and develop personalized care plans.
• Utilize community resources and funding to support members' care plans effectively.
• Monitor member progress, ensuring plans are adjusted to meet evolving needs.
• Educate members on health interventions to improve outcomes and reduce expenses.
• Document all case management activities comprehensively and accurately.
• Evaluate medical necessity and appropriateness of services for case management candidates.
• Develop and implement policies, procedures, and training programs as needed.

Job Requirements

• Bachelor of Science in Nursing (BSN) with valid NC or compact multi-state clinical license.
• Minimum of 3 years of clinical or case management experience; 5 years preferred.
• Specialty certifications such as CCM or CDCES required within 2 years of employment.
• Experience in Behavioral Health and applicable licensure preferred for specific roles.
• Proficiency in developing care plans and utilizing community resources effectively.
• Strong documentation skills to ensure accurate and comprehensive case management records.
• Ability to educate members on proactive health interventions and resource utilization.
• Familiarity with evaluating medical necessity and appropriateness of care services.