Department: Care Management
Reports to: Care Management Supervisor
The Care Manager is an integral part of Integra’s Care Management Team. The Care Manager works in conjunction with the medical social worker, and a service coordinator. All members of the care management team interact with the member, thereby assuring continuity for the member in the delivery and coordination of services.
Essential Job Duties:
- Develops and updates individualized care plan based on comprehensive assessment of members in consultation with the member and family/caregiver and the assessment nurse;
- Implements the care plan and authorizes/arranges for delivery of covered services consistent with the care plan;
- Conducts ongoing communication and collaboration with member, family caregiver, or member’s designated representative, as well as with member’s PCP and other significant health care providers;
- Monitors provision of services by Integra’s network providers to ensure they are appropriate and in accordance with the member’s care plan;
- Conducts ongoing monitoring of member’s health, safety, and functional status, and progress towards established goals;
- Provides coordination of care transitions, including discharge and transition planning from hospital or nursing homes;
- Determines member eligibility for Integra’s program and quality initiatives that may include but not be limited to: diabetes management program, falls prevention program, physician home visiting program, tele-health program, etc.
- Facilitates establishment of Advance Care Planning and assuring appropriate administration of the member’s Health Care Proxy.
- Reviews member’s medical status and issues, identifying follow up issues;
- Serves as primary contact with member’s PCP or specialist physicians as well as member’s long term care service providers;
- Monitors member’s medication adherence;
- Counsels member on his/her medical condition and provides education/coaching on self-management or care giving by family members;
- Conducts monthly outreach to member to check on member’s status;
- Updates member case records.
- Participate in Quality Assurance and Improvement activities as directed by Director of Clinical Management
- Other duties as assigned by the Care Management Supervisor and/or the Director of Care Management.
- NYS license and current registration as a registered nurse;
- Minimum of two years of experience in clinical practice;
- Experience in managed care and/or care management preferred;
- Experience with geriatric population preferred.
- Preferred qualifications for a Care Manager include a Bachelor's or Master's degree in health, human or education services and one year of care management experience.