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Care Manager, Complex (CHF)

Open Position: Care Manager, Complex (CHF)
Location: Memphis, TN
Type: Full-time

Position Summary:
The Care Manager is responsible for the overall assessment and coordination of services and care needed by members with chronic and complex health conditions, to help members achieve an optimal level of health and productivity.

Responsibilities include conducting face-to-face and telephonic assessments, identification of members with specific chronic and high risk conditions, engage with providers, acts as an advocate, care plan development, establish community linkages, management of critical transitions, develop and implement strategies to improve the health of a population, monitor hospitalization utilization, coordinate care with care providers, assess and monitor member status, and assist in the promotion of Care Management Programs.

Job Responsibilities:

  • Conduct thorough and objective initial and ongoing telephonic and face-to-face assessments of the member to determine current and change in status and needs, including physical, behavioral, functional, psychosocial, financial and health status expectation.
  • Identify and recruit members using multiple approaches, with the potential for high-risk complications, and coordinate the appropriate supported self-care in conjunction with the member and care coordination team. Identification of potential cases may be through data, referral, and telephonic outreach.
  • Engage with member's primary care provider, specialists and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care; facilitates designation of provider to assume primary medical care responsibility where needed.
  • Act as an advocate for an individual's care needs by identifying and communicating opportunities for care interventions, including identifying and addressing functional deficits and gaps in care.
  • Develop member-specific Plans of Care that will be utilized to obtain authorizations for appropriate home and community-based services, collaborating with staff to obtain authorization for those services and confirms that services are being provided and the member's needs are being met while transitioning from medical facility to home.
  • Establish connections between members, providers and the community resources including advocates, navigators, psychosocial networks, support groups and financial supports and serves as a point of contact for coordination of all related services.
  • Manage critical transitions, supporting legacy discharge planning staff with member transition to the home setting.
  • Monitor hospitalizations and institutional facility admissions and re-admissions to identify issues and implement strategies to improve outcomes.
  • Develop and implement targeted strategies to improve health, functional or quality of life outcomes, such as chronic disease management or pharmacy management.
  • Routinely assess and monitor member's status, needs and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to their plan of care, providers and/or services to promote better outcomes.
  • Report quantifiable impact, quality of care and/or quality of life improvements as measured against the care coordination goals.
  • Establish and maintain professional working relations with referral sources, community resources and care providers.
  • Assists team in the development and modification of the Care Management Program.
  • Assists in the promotion of the Care Management Program to providers and customers.

Requirements:

  • Bachelor’s degree in Nursing.
  • Current, unrestricted RN license in the State of TN or the ability to obtain prior to employment, or compact license agreement in place.
  • 2+ years of experience in a hospital or acute care setting with direct care experience.
  • 2 + years Case Management experience.
  • Case Management Certification, ACM or CCM; or successfully completes board certification within 2 years of hire.
  • Strong written and verbal communication skills with the ability to work with members, their families, and physicians in a tactful and professional manner.
  • Ability to drive up to 1+ hours each way to members' homes for visit.

Additional Assets Preferred:

  • Experience in managed care, discharge planning, care coordination.
  • 1+ years of home care experience or specialty clinic experience.
  • Experience working with multidisciplinary teams preferred. 

Resume with cover letter and references can be submitted via email to Sarah.Henning@myhealthchoice.com