RN Job In Louisville, Kentucky
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The Care Manager will be responsible for The Care Manager (CM) will use clinical and CMSA standards to provide care management to Beacon members on an ongoing basis
ABOUT THE POSITION
We are currently seeking a dynamic Care Manager to join our team at our office in Louisville, Kentucky. The Care Manager will be responsible for The Care Manager (CM) will use clinical and CMSA standards to provide care management to Beacon members on an ongoing basis, within the members benefit package. The CM will initiate and maintain communication with members, Primary Care Physicians, Behavioral Health Providers and other health team members regarding care management plans to collaborate to meet members' needs. The CM is responsible for conducting outreach, assessment, and care coordination/management for identified Medicare Medicaid Alignment. The CM works closely with Health Plan medical care managers, social care managers and others to ensure quality and effective service and support to members, as well as, coordinate amongst all interdisciplinary Care Team (ICT) members to develop the Individualized Care Plan (ICP) and oversee ICP implementation.
- Complete comprehensive assessment of the medical, behavioral health and psychosocial needs of identified members and their families when delegated by the Health plan.
- Establish and implement culturally competent care management plans to meet the needs of members.
- Create patient centered and culturally competent Individualized Care plan (ICP) to include problem identification, goal-setting, interventions and expected outcomes
- Facilitate and coordinate the appropriate services and supports to meet the needs of enrollees, particularly high-risk populations.
- Provide health coaching and education to members related to health care conditions and treatment plans with a focus on medication and treatment adherence, appropriate use of emergency room, and navigation of the health care system.
- Direct members to self-management tools and resources and support in their use.
- Collaborate with medical and social care managers and Pharmacy to develop a comprehensive and integrated approach to care coordination.
- Participate in rounds forums to promote integrated case discussions and problem-solving
- Make timely referrals for community based services.
- Document care management activities in FlexCare and /or Health Plan Electronic Health Record according to Beacon Standard Operating Procedures.
- Complete care activities in a timely manner and meet compliance requirements for the state Medicaid regulatory HSAG, Medicare NORC, NCQA, and Beacon Clinical Management department standard operating procedures.
- Demonstrate flexibility and creativity in the design of innovative and individualized care plans in order to achieve maximum effectiveness and optimal outcomes for members and their families.
- Participate in member/family meetings to support integrated efforts and collaboration with the health care team
- Provide assistance, advocacy, and empowerment to members in efforts to achieve optimal health
- Supervising a caseload and ensuring all care management activities meet all compliance requirements
- Develop or oversee the ICP for each member in collaboration with all team members, adhering to timelines and including assessment of health needs, individualized care management plans, implementation, monitoring and evaluation of care outcomes.
- When delegated, oversee the clinical process and model of care as delivered by a community based Case Management agency.
- Collaborate with PCP, BHPs, other members of the health care team, Health Plan Complex Care Managers, Social Care Managers, Pharmacy, and others to arrange and coordinate services for the member to help member reach their highest level of functioning and optimize the member's ability to engage in the appropriate plan of care.
- Other duties as assigned
- 35% local travel
Master's Degree in a health and/or human service related field
Licenses: Valid Unrestricted license as a LCSW, LCPC, Clinical Psychologist, RN or other master's level behavioral health professional required.
Years and Type of Relevant Work Experience: At least 3 years' experience with SMI population in acute care settings, or case management programs, strong organization skills, ability to multi-task, and proficiency in Word, Excel, and PowerPoint required. Kentuck Medicare and Medicaid, Waiver and Consent decree experience highly preferred. Excellent communication skills (verbal and in writing). Experience working with individuals of different cultural and ethnic backgrounds preferred. Ability to manage multiple priorities and work collaboratively within a team environment required. Managed care experience with familiarity with Medicaid and Medicare populations preferred
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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled
AAP Reporting Location:
KS - Topeka
ID (Req #):
Monday-Friday 8:30 am - 5:00pm