Manager Care Job Description
Manager Care Duties & Responsibilities
To write an effective manager care job description, begin by listing detailed duties, responsibilities and expectations. We have included manager care job description templates that you can modify and use.
Sample responsibilities for this position include:
Manager Care Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Manager Care
List any licenses or certifications required by the position: CPR, CCM, CMS, CCP
Education for Manager Care
Typically a job would require a certain level of education.
Employers hiring for the manager care job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Nursing, Health, Education, Health Care, Substance Abuse, Social Work, Healthcare, Social Sciences, Human Services, Management
Skills for Manager Care
Desired skills for manager care include:
Desired experience for manager care includes:
Manager Care Examples
Manager Care Job Description
- Meet daily with Medical Director to review all TOC patients to ensure appropriate care and to ensure that clinic is obtaining Medicare payment for transition of care services
- Act as the practice’s leading source of knowledge on medical neighborhood resources and their policies and business practices
- Assist members and providers who call to understand treatment options and available services, explanation of benefits
- Facilitate and coordinate the appropriate services and supports to meet the needs of enrollees, particularly high risk populations
- Direct members to self-management tools and resources and support in their use
- Consults with Beacon’s Physician Advisors (PA) when requests for services do not meet medical necessity criteria
- Provides information to members and providers regarding mental health and substance abuse benefits and community treatment resources when appropriate
- Assess patients care management needs via patient intake assessments
- Conducting case conferences for development of care management plans for target patient populations in collaboration with primary care physician and other care team members and ancillary providers
- Implementing specific care coordination activities or interventions to achieve the goals set by the Primary Care, Quality and Care Management teams
- HealthQuest Wellness Program
- Experience in TAY, older adults with MH/SA conditions, SMI, SUD, co-occurring disorders (MH with SUD, IDD or physical health)
- Re-verification will take place no less than every 3 years.Valid California State Clinical License required (RN, LCSW, MFT, LPCC, PhD or PsyD)
- In states where appropriate, must maintain certifications (CNA or HHA)
- Current license to practice professional nursing in the state of Pennsylvania required
- Inpatient clinical nursing experience in an acute hospital setting with two (2) years experience in the population to which the individual is to be assigned required or 2 years relevant CM/UM experience in another healthcare setting
Manager Care Job Description
- Performs systematic assessment and reassessment of patient and family/significant other considering clinical presentation, cultural and religious influences, individual experiences, available resources, environmental factors health behaviors and practices
- Specific state specialty programs may require initial and annual training hours related to the area of specialty
- Manage transitions of care
- Maintain a spreadsheet to monitor and manage any new or existing transition of care patients
- Provide initial treatment plan clinical reviews, concurrent treatment plan reviews, case consultations and determine level care based on medical necessity
- Coordinating outpatient discharge planning with the practitioner to assure continuity of care
- Verify member coverage and advise all parties involved of the implications for treatment
- Provide input into the development of case management systems
- Completes a comprehensive assessment of the medical, behavioral health and psychosocial needs of identified members and their families when delegated by the health plan through the ICM assessment process, enrollment and trigger reports, and other case identification sources, and establishing and implementing culturally competent care management plans to meet the needs of members
- Completes face to face visits with members and their families within inpatient settings and/or their homes on an as needed basis
- Excellent interpersonal skills and communication style
- Ability to form positive, collaborative relationships with hospital staff, patients, families and post-acute providers
- BSN Degree required.Valid NJ RN License and valid driver's license required
- 2-4 years clinical patient care experience in acute care setting and/or chronic disease management required
- Experience with standard office technology in a Window based environment preferred
- Experience with standard office equipment (phone, fax, copy, machine, scanner, email/voicemail) preferred
Manager Care Job Description
- Provides transitional care services to members being discharged
- Coordinate services for a caseload of approximately 55 clients
- Provide Health Home services for Adults with medium or high acuity
- Identify needs and coordinate services relevant to the Plan of Care
- Provide education to individual concerning Health Home services, along with information concerning conditions being treated
- Facilitate and coordinate the appropriate services and supports to meet the needs of members, particularly high risk populations
- Directs members to self-management tools and resources and provides support of their use
- Facilitates and coordinate the appropriate services and supports to meet the needs of enrollees, particularly high-risk populations
- Directs members to self-management tools and resources and support in their use
- Support data collection, quality assurance, process improvements, and ongoing training activities as requested by Health Home leadership
- Valid NJ RN License and valid driver's license required
- Collaborates with physicians regarding discharge planning
- Refers to Social Work for complex discharge planning
- Works closely with physicians and healthcare team to ensure the patient an appropriate plan of treatment and a safe transition to home
- Performs on-call duties responsibly and other duties as assigned to include cross coverage for RN roles in Care Management Department
- 1+ year of experience in care/case management
Manager Care Job Description
- Interact with Physician Advisors and Utilization Review Clinicians to discuss clinical questions, authorizations, alternative treatment options and concerns regarding specific cases
- Meet strict deadlines and established cycle times through effective prioritization and follow-up skills in order to provide excellent care management services to all members assigned to ICM caseload
- Demonstrate knowledge about services and utilize creativity to consider how to meet member's needs
- Manages members experiencing crisis episodes and facilitates coordination of care as needed
- Demonstrates 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
- Participates in facility based treatment team meetings to support integrated efforts and collaboration with the health care team
- Provides assistance, advocacy, and empowerment to members in efforts to achieve optimal health
- Reports to each scheduled shift on time
- Serves as a mentor to junior team members through leadership and guidance based on integrity, positive example and a sense of team cohesiveness
- Assists team members and offers suggestions to improve processes, training, culture, or work environment
- Familiarity with general office and computer products, and a familiarity with computer programs and technology
- Experience in an educational context
- Advanced computer skills, Minimum Required
- Must have ability to interact effectively with a variety of people and situations at all levels of the organization, Minimum Required
- Master's level or Associate for RN
- Knowledge and experience in inpatient and/or outpatient setting
Manager Care Job Description
- Help clients achieve wellness and autonomy and better understanding of how to use a variety of health services
- Triage and manage members referred to Case Management identified as ICM who may be high risk, high utilizing, at significant clinical risk or under-utilizing services
- Facilitate and coordinate the appropriate services and supports to meet the member’s perceived needs
- Complete care management 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
- Utilize benefit structures and community-based resources to meet member's needs
- Provide home health services for children at medium or high acuity
- Provide education to family and child concerning home health services
- Assist and advocate for families and children in the attainment and maintenance of public benefits, such as financial, educational, social, and community services
- Maintain quality assurance systems to ensure that services are in place for clients and documentation is complete and up to date
- 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
- LCSW in the Commonwealth of Pennsylvania
- Two to Three years of post-graduate clinical experience
- Experience working in the managed care industry preferred
- Clinical assessment & crisis intervention skills
- Required must have or become IM-CANS certified within 30 days of hire/start and be re-certified annually
- Required intermediate knowledge and skills of MS Office including Excel, Word and Outlook Express