Care Manager - Chappaqua, United States - TRI-COUNTY CARE LLC

TRI-COUNTY CARE LLC

Verified Company

Chappaqua, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Overview:

The role of the Care Manager is to deliver the 6 core services in a person-centered manner in order to meet the needs of the individual, the OPWDD valued outcomes, the objectives of the People First Transformation, and the State requirements.

The Care Manager provides referral and linkage to benefits and services, and in-person visits with members ranging from monthly to bi-annually dependent on the need of each member.

Essential Responsibilities:

Provide comprehensive, person-centered Care Management services focusing on the 6 core services:

Comprehensive Care Management
Complete a Comprehensive Assessment for each individual that identifies medical, mental health, chemical dependency, developmental disability, and social service need
Develop a Life Plan with the individual; include family, collaterals, and service providers in fulfillment of the Life Plan; parties should agree with the goals, interventions, and timeframes
Caseload size up to a weight of 20, generally 3540 members, but may vary
Conduct facetoface visits as required (Monthly, Quarterly, or Bi-Annually dependent on regulatory requirement and individual needs of each individual)
Care Coordination and Health Promotion
Engage the individual in the adherence to treatment recommendations, monitor and evaluate individual's needs; coordinate all aspects of the individual's care; develop relationship between the care planning team
Review and update the Life Plan with the care planning team; initiate changes in care
Ensure timely access to appointments for individuals to medical/behavioral health care services; link individuals with resources
Collaboration with both internal and external interdisciplinary teams.
Instituting recommendations from internal clinical teams
Involvement in posthospital/rehabilitation discharge
Comprehensive Transitional Care
Assist the individual to transition between levels of care, or after critical events, such as: hospital, school, rehabilitation facility, etc., follow up in a timely manner post discharge, support individual during crisis events
Use Health Information Technology to facilitate collaboration among all providers
Individual and Family Support
Communicate and share information with individuals and their family/representative, ensure that the Life Plan reflects the individual's and their family/representative's preferences
Utilize peer supports, support groups to increase family/representative's awareness
Provide monthly contact and engagement with all members/families
Follow up to strive for complete member satisfaction with TCC and external services
Referral to community and social support services
Identify available resources and actively manage referrals, engagement, and followup
Ensure that the Life Plan includes communitybased and other social support services that respond to the individual's needs and preferences and contribute to achieve the individual's goals
Use of HIT link services
Meet the HIT standards in the delivery of core services and the Life Plan, as described in the manual
Maintain written documentation of service delivery and individuals' information on the Electronic Health Record System while practicing all HIPAA and Privacy regulations

**Applicant must be fluent in both English &
Spanish**
This position requires a quiet distraction free environment for working, or the ability to work from one of our regional offices.
***
Additional Responsibilities:

Monitoring/Assisting individuals with maintaining benefits (Food Stamps, Medicaid, and SSI)
Support individuals with P&P related to schooling, and any relevant issues
Report any incident of abuse, neglect, or maltreatment immediately
Other duties as assigned/requested

Specific Knowledge, Skills, and Abilities:

Excellent interpersonal skills, including conflictmanagement and knowledge of deescalation techniques
Advanced ability to effectively communicate in both verbal and written manner
Computer software skills, particularly skills with Microsoft Suite
Ability to organize, schedule, and utilize time well
Capability to analyze situations accurately, prioritize, and take effective action

Required Education, Experience, and Licenses:

-
A Bachelor's degree with two years of relevant experience, OR
-
A License as a Registered Nurse with two years or relevant experience, which can include any employment experience and is not limited to case management/service coordination duties, OR
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A Master's degree with one year of relevant experience
-
MSC Service Coordinators prior to July 1, 2018 are "grandfathered" to facilitate continuity of care

_ This job description is not all inclusive and the employee may be asked to assume additional responsibilities as the need arises._
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