Responsible for the assessment, reassessment, care planning and coordination of care and services. Includes ongoing monitoring of an appropriate and effective person centered care plan, member education and care management. Regularly communicates with the members' PCPs and other providers, and integrates the member, caregiver and other provider feedback into the assessment and planning.
Ensures continuity of care for newly enrolled members.
Identifies and prioritizes the members' needs and preferences.
Develops quantifiable goals and desired outcomes, and promotes the members' ability to self-manage to the greatest extent possible.
Develops, implements and monitors the Person Centered Service Plan, assisting members in obtaining reasonable accommodations when appropriate.
Manages case load, including risk stratification of members, monitoring reassessment needs and facilitating transitions of care settings.
Serves as the primary point of member contact.
Assesses member needs, manages care and services, and ensures effective communication among members, caregivers, providers and community supports.
As the lead of the interdisciplinary team, facilitates the activities and communication within an interdisciplinary team of providers, vendors, facilities, discharge planners, field nurses, social workers, care coordinators, and member/caregivers to effectively manage care plans and transitions of care settings.
Maintains timely, complete and accurate documentation using both hard copy and technology based solutions in compliance with regulatory policies and procedures.
Gathers and summarizes data for reports.
Supports initiatives of the Quality Assessment and Performance Improvement Committee.
Other Job Requirements
Responsibilities
Understands and is able to apply principles of Care Management and Person Centered Service Planning.Ability to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines.Ability to understand and apply coverage guidelines and benefit limitations.Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses (depression, challenging behaviors, Alzheimer's disease and other disease-related dementias).Understands and adapts appropriately to issues related to communication, cognitive or other barriers.Ability to lead an interdisciplinary care team.Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner.Comfortable with conducting home visits and commuting within the service area.Minimum 3 years' clinical experience with focus in managed care, including disease or case management.
General Job Information
Title
Care Manager
Grade
25
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Associates - Nursing
Education - Preferred
Bachelors - Nursing
License and Certifications - Required
RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
CCM - Certified Case Manager - Care Mgmt, CCP - Chronic Care Professional - Care Mgmt
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
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Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.
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