Care Manager

Care Manager will be the point of contact for all communication among care team members and is the primary point of contact for the individual being served. The Care Manager completes a comprehensive assessment and develops a unified plan of care for Tailored Plan recipients and relays communication among providers of various health services. The Care Manager will provide multiple services to the Mental Health and Substance Abuse population. This will include prevention, outpatient, residential, and transitional programs for adults, adolescents and family members. These services will seek to help members obtain all social determinants of health which may include but are not limited to screenings, evaluations and assessments, habilitative supports and therapies, case management, emergency interventions, day treatment, medical detoxification, medication management, referrals and education.

Complete Assessment/Planning

· Complete comprehensive assessments at enrollment, yearly or at changes in condition.

· Develop Care Plans derived from the completed assessments

· Assign interventions/plans of care to the Extender or Care Worker for monitoring and service engagement activities

· Submit referrals for physical health or behavioral health when the need indicates medical and/or pharmaceutical complexity

· Assign Care Plan activities to the Extender or Care Worker if member has identified Social Determinants of Health (SDOH), or other complex payer issues

· Assist individuals/legally responsible persons in choosing service providers

· Consistently evaluates appropriateness of services and ensures implementation of plan of care through information gathering and assessment at defined frequency of contact based on risk stratification

· Actively collaborate with care team, members supported, and service providers to ensure development of a plan that accurately reflects the individual’s needs and desired life goals

Provide Support and Monitoring

· Schedule initial contact with member to verify accuracy of demographic information.

· Update inaccurate information from the Electronic File

· Schedule face to face meeting with member and other team members to provide education about Care Teams, and services

· Provide education and support, to individuals and other supports, in learning about and exercising rights, explanation of the grievance and appeals process, available service options, providers available to meet their needs, and payer requirements that may impact service connection and maintenance.

· Refer members who are in crisis/institutional care settings and require assistance with returning to community-based services, to the appropriate clinical consultants

· Recognize and report critical incidents and provider quality concerns to care management supervisors

· Coordinate with other team members to ensure smooth transition to appropriate level of care.

· Attend treatment meeting with member, natural supports and selected providers.

· Schedule, coordinate and lead team conference calls on behalf of member needs

· Communicate with member to check on status, verify care needs are met and that no new clinical needs warrant a change in condition assessment.

· Promote customer satisfaction through ongoing communication and timely follow-up on any concerns/issues.

· Verify that ongoing service adherence is maintained through monitoring.

Documentation

· Obtain and upload all supporting documentation, LRP verification, and release of information that will improve care management activity on behalf of the member

· Document all applicable member updates and activities per organizational procedure.

· Escalate complex cases and cases of concern to Supervisor.

· Ensure that service orders/doctor’s orders are obtained, as applicable.

· Share appropriate documentation with all involved care team members as consent to release is granted.

· Obtain releases/documentation and provides to all care team members involved.

· Obtain clinical supporting documentation, legal/guardianship verification, and necessary consents to exchange/release information

· Ensure all clinical documentation (e.g. goals, plans, progress notes, etc.) meet state, agency documentation standards, and Medicaid requirements