Case Manager Long-term Care - Delaware

📋 Description

• • Serve as the primary point of contact for members, orchestrating comprehensive care coordination across diverse service delivery systems and community support networks.
• • This is a full-time, community-based role requiring significant travel within the assigned territory in Delaware, with a substantial focus on direct member engagement in their homes and within nursing facility settings.
• • Conduct regular, in-person visits to members' residences, nursing facilities, and other community-based locations to perform thorough needs assessments, supplemented by telephonic follow-ups, all in strict adherence to state and national guidelines, policies, and procedures.
• • Actively engage within nursing facility environments, participating in care plan conferences to ensure all member needs are comprehensively addressed.
• • Perform holistic assessments, planning, coordination, implementation, and evaluation of care for eligible members facing chronic and complex healthcare, social service, and custodial needs, whether in a nursing facility or a home and community-based care setting.
• • Facilitate seamless care coordination across the entire continuum of services, addressing members' physical, behavioral, long-term services and supports (LTSS), social, and psychosocial needs in the safest, least restrictive, and most cost-effective manner possible.
• • Ensure smooth and effective care transitions between home, community, and various community-based care settings.
• • Authorize LTSS services following the completion of a comprehensive needs assessment, coordinating Home and Community-Based Services (HCBS), Medicaid, and DSNP benefits, and evaluating the appropriateness of care and services within the community.
• • Drive transitions to alternative care settings, such as facilitating hospital-to-home or nursing facility-to-community transitions, by leveraging an integrated care team to meet the member’s unique needs.
• • Educate members and their caregivers about their healthcare requirements, available benefits, community resources, and service options, including detailed information on long-term care choices, whether community-based or facility-based.
• • Provide targeted education, resources, and support to empower members in achieving their care plan goals and overcoming any barriers to optimal care within the least restrictive environment.
• • Develop personalized, individualized care plans collaboratively with members and/or their caregivers, clearly identifying services required to meet specific needs and achieve desired outcomes.
• • Proactively identify and secure necessary resources to support a fully integrated care coordination approach, including facilitating referrals to specialized programs such as Disease/Chronic Condition Management, Behavioral Health, and Complex Case Management.
• • Collaborate effectively with the member's multidisciplinary healthcare and service delivery team, including physical and behavioral health providers, the Integrated Care Team (ICT), and discharge planners, to coordinate care needs and community resources, ensuring the member remains in the safest, least restrictive environment possible.
• • Assist members in developing, implementing, and amending contingency plans to address potential gaps in provider coverage.
• • Verify that approved support services are being delivered as stipulated in the member's care plan.
• • Continuously evaluate the effectiveness of the service plan, making necessary revisions in accordance with established policies, procedures, and state contractual requirements.
• • Support members in overcoming obstacles to achieving optimal care by connecting them with relevant community resources and formulating appropriate action plans in conjunction with providers.
• • Meticulously document all case management services and interventions within the electronic health record system.
• • Strictly adhere to all company, State, and Federal requirements pertaining to privacy practices, HIPAA, and quality performance standards.
• • Undertake other duties as assigned or requested to support the team and organizational objectives.