Care Manager Ii, Ltss, Rn/Lcsw

Responsibilities:
The Care Manager (RN/LCSW) assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Care Manager (RN/LCSW) is responsible for engaging the member, member care giver and providers to assess plan and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care management program.

• Assess members through face to face encounter or by telephone to determine care coordination and care management needs for all referred members.
• Completes comprehensive person centered assessment inclusive of physical health history, mental health history, social determinants of health and supportive needs.
• Coordinates physical, behavioral health and social services;
• Provides medication management, including regular medication reconciliation and support of medication adherence;
• Identifies problems/barriers for care coordination and appropriate care management interventions.
• Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health.
• Identifies goals and assigns priority with associated time frames for completion. Shares goals with the member and family as appropriate.
• Identifies and implements the appropriate level of intervention based upon the member's needs and clinical progress.
• Schedules follow up calls as necessary, makes appropriate referrals. Implements actions to address member issues. Documents progress towards meeting goals and resolving problems.
• Coordinates care and services with the Care Coordinator, Community Health Navigator, and member or member's care giver, as appropriate, PCP, Specialist, and Facility/Vendor Providers.

• Qualified candidates will reside in North Carolina, either in or local to Greensboro or Winston-Salem.
• Current and unrestricted Clinical Social Work license in North Carolina.
• Current and unrestricted Registered Nurse license in North Carolina.
• 3 years of case management preferred.
• Knowledge in PCS assessments desired.
• 3 years professional clinical practice experience to include home health.
• Valid driver's license with car insurance.