BLEHEALTH, LLC

Compensation

Full Description

The Lead Care Manager works in collaboration and continuous partnership with chronically ill or “high-risk” members and their family/caregiver(s), clinic/hospital/specialty providers and staff, and community resources in a team approach to: · Coordinate with those individuals and/or entities to ensure a seamless experience for the member and non-duplication of services · Engage eligible members · Oversee provision of ECM services and implementation of the care plan. · Offer services where the member lives, seeks care, or finds most easily accessible and within the Plan guidelines · Connect member to other social services and supports the member may need, including transportation · Advocate on behalf of members with health care professionals · Use motivational interviewing, trauma-informed care, and harm-reduction approaches · Coordinate with hospital staff on discharge plans · Accompany member to office visits, as needed and according to the Plan guidelines · Monitor treatment adherence (including medication) · Provide health promotion and self-management training · Promote timely access to appropriate care · Increase utilization of preventative care · Reduce emergency room utilization and hospital readmissions · Increase comprehension through culturally and linguistically appropriate education · Create and promote adherence to a care plan, developed in coordination with the member, primary care provider, and family/caregiver(s) · Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals · Increase members’ ability for self-management and shared decision-making · Connecting members to relevant community resources to enhance member health and well-being, increase member satisfaction, and reduce health care costs · Connect and follow up with members, family/caregiver(s), providers, and community resources via face-to-face, secure email, phone calls, text messages, and other communications · Serve as the contact point, advocate, and informational resource for members, care team, family/caregiver(s), payers, and community resources · Work with members to plan and monitor care · Assess member’s unmet health and social needs · Develop a care plan with the member, family/caregiver(s), and providers (emergency plan, health management plan, medical summary, and ongoing action plan, as appropriate) · Monitor adherence to care plans, evaluate effectiveness, monitor member progress on time, and facilitate changes as needed · Create ongoing processes for members and family/caregiver(s) to determine and request the level of care coordination support they desire at any given time · Facilitate member access to appropriate medical and specialty providers · Educate members and family/caregiver(s) about relevant community resources · Facilitate and attend meetings between members, family/caregiver(s), care team, payers, and community resources, as needed · Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals · Assist with the identification of “high-risk” members (the chronically ill and those with special health care needs), and add these to the member registry (or flag in EHR) · Attend all Lead Care Manager training courses/webinars and meetings · Provide feedback for the improvement of the ECM Program · Offer services where the Member lives, seeks care, or finds most easily accessible and within Medi-Cal Managed Care health plans (MCP) guidelines · Engage eligible Members · Arrange transportation · Call Member to facilitate Member visit with the ECM Lead Care Manager QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below represent the required knowledge, skill, and/or ability. Reasonable accommodations may enable individuals with disabilities to perform essential functions. · Although this role is remote, there will be times when you will be required to report to our satellite office (or a specified, remote location) to work, to attend meetings, or other training · Required to have and maintain your own personal vehicle for this role o You will receive a monthly mileage reimbursement per applicable state/federal laws · You must have a valid driver’s license, proof of insurance, and a good driving record · You will visit hospitals and visit patients at their homes, as needed · Must present proof of Negative TB Test & CPR Certification before hire date EDUCATION AND/OR EXPERIENCE: · An associate’s degree, or bachelor's degree in health science or any related health care degree is preferred · Social Worker, LVN, or experience in case management is a PLUS! SKILL AND KNOWLEDGE REQUIREMENTS: · Excellent analytical, problem-solving, and prioritization skills · Excellent verbal and written communication skills · High-level of interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams that may include employees, customers, and physicians · Effective computer skills, particularly Microsoft Office, Excel, PowerPoint, Word, etc. · Work independently to complete assigned tasks · Team building · Project Management · Change Management · Quality and Process improvement tools • MUST consistently achieve a minimum daily expectation of 30 schedules/day