Description DEPARTMENT
- Health programs
- Department
- Accountability:
- Reports to
- SOURCE
- Program
- Manager
- STATUS: Exempt, Full-time- TBD schedule
JOB SUMMARY Provides comprehensive case management services for a caseload of 75+ members with complex health, long-term care, and social service needs.
Develops, implements, and monitors person-centered care plans in collaboration with members, families, caregivers, healthcare providers, and community partners.
Conducts ongoing assessments through regular phone and in-home visits to evaluate needs, coordinate services, and ensure care plan goals are achieved.
Serves as a liaison among clients, providers, and community agencies to facilitate access to resources, resolve concerns, and maintain continuity of care.
Monitors service utilization, program compliance, and quality outcomes while maintaining accurate documentation and adherence to regulatory requirements, HIPAA standards, and agency policies.
Participates in multidisciplinary care team meetings, supports eligibility and appeals processes, and advocates for member well-being, independence, and access to appropriate services.
Serves large geographic areas which may include parts of one large county and/or many small counties.
Travel involved.
Duties and Responsibilities
- Essential Functions
- Manages a minimum caseload of 75 members/clients.
- Develops, implements, monitors, and updates comprehensive, person-centered care plans in collaboration with the client, family, caregivers, physicians, and service providers.
- Meets standards of promptness for new admission contacts, monthly phone contacts, in-home visits, and 90-day reassessments, documenting all activities within the designated data management system.
- Conducts monthly telephone contacts and face-to-face visits every 90 days to assess needs, monitor service effectiveness, and ensure care plan goals are being met.
- Acts as a liaison between members/clients, families, providers, physicians, and community partners to resolve concerns, address non-compliance issues, and coordinate services.
- Creates and adjusts service orders as necessary and troubleshoots billing concerns.
- Brokers and coordinates services as needed to support the implementation of the person-centered care plan.
- Arranges and coordinates community-based services and other support resources as appropriate.
- Communicates and collaborates with all agencies, providers, and organizations involved in the member's/client's care to ensure continuity and quality of services.
- Participates in multidisciplinary case conferences with nursing staff, medical directors, supervisors, and service providers to review care plans, hospitalizations, levels of care, areas of non-compliance, and ongoing needs.
- Maintains knowledge of applicable state regulations, program requirements, policies, and procedures governing service delivery.
- Reviews and monitors service utilization and costs to ensure compliance with program guidelines and established funding limitations.
- Oversees service delivery to verify that members/clients receive appropriate, effective, and person-centered care.
- Maintains accurate, complete, and timely documentation in accordance with agency and program requirements.
- Reports suspected abuse, neglect, or exploitation to appropriate agencies, including LTCO, APS, OIG, ORS, CPS, or other regulatory entities, as required.
- Communicates with eligibility and benefits agencies regarding program eligibility, renewals, and related matters.
- Assists members/clients with appeals and hearings, including the preparation and submission of required documentation and records.
- Collaborates with hospitals, home health agencies, nursing facilities, social workers, community organizations, and other stakeholders to support member/client well-being.
Requirements
EDUCATION, EXPERIENCE AND SKILL REQUIREMENTS Education: · Bachelor’s degree in social work, Psychology, Sociology or related field or Registered Professional Nurse currently licensed to practice in the state of Georgia Knowledge and Experience: · Two (2) years of experience in human services or health related field
Skills
· Ability to effectively coordinate and communicate with clients, service providers, general public, and other staff members · Skill in establishing and sustaining interpersonal relationships · Knowledge of human behavior, gerontology · Skills in team building and group dynamics · Knowledge of community organization and service system development · Problem solving skills and techniques · Knowledge and skill in social and health service intervention techniques and methodology · Proficient computer skills
Licensure and Certification
· Valid State Driver’s License
PHYSICAL AND MENTAL DEMANDS The physical and mental demands described are representative of those that must be met by an employee to successfully preform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job, on a case-by-case basis. · Regularly required to use hands to write, use computer, operate a motor vehicle, use hand-held device and telephone, and manipulate documents. · Regularly required to read documents and write neatly, legibly, and transcribe accurate information and numbers/values. · Continually engages in activities that require talking and hearing · Frequent: Standing, sitting, walking, bending, repetitive use of hands, simple grasping and fine hand manipulation, pushing, and pulling. Occasionally required to lift or reach above shoulder level, climb, twist, squat, kneel, crouch or crawl. · Must be able to lift up to 11 pounds, and occasionally up to 25 pounds. · Ability to respond appropriately to emergency situations. · Ability to read and interpret a variety of instructions in written, oral, diagram, or schedule form. · Ability to apply common sense understanding to carry out detailed written or oral instructions. · Ability to deal with problems. · Some local and regional travel required · Local Travel required (50-75%) · Attendance at off-premises meetings, conferences or trainings. (25%, overnight)
WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job, on a case-by-case basis. · This job operates in an office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. · Temperature ranges from normal indoor climate-controlled environment in buildings or vehicles, various outdoor conditions and temperature extremes encountered during off-site travel, and unpredictable indoor environmental conditions encountered during off-site travel, and unpredictable indoor environmental conditions encountered at off-site locations. · Noise level is generally quiet to moderate. The Legacy Link, Inc. is an Affirmative Action/Equal Opportunity Employer.
