Case Manager

JOB SUMMARY

An Advantage Case Manager is responsible to carry out the case management process as outlined by the case management standards of operation set forth by Oklahoma Department of Human Services MSU and directed under the supervision of CMS and/or Excell Private Care Services management team. Activities to include but not limited to: admission/intake, assessment/reassessment, services plan implementation, monitoring/evaluation, and discharge of members. The roles assumed by the case manager within the long-term care services delivery system are services coordinator, member advocate, member consultant, good steward of state funds and gatekeeper.

DUTIES & RESPONSIBILITIES

• Establish intake, screening, and referral procedures for information requests about community long-term care options and admitting only those consumers determined eligible by OKDHS.

• Review the comprehensive assessment and/or complete reassessment, as needed, to identify member needs, goal, abilities, resources, and support as the basis for service planning. Complete documentation & submit within specific timeframe.

• Orients and provides on-going education to consumers as needed to empower them as informed and active members.

• Ensures coordination of available community resources and informal support, for which the member is eligible and/or has needs.

• Submits a comprehensive, written service plan for each member per the interdisciplinary team (IDT) process that establishes service goals, meets identified member needs, promotes independence, uses the most effective and cost efficient formal and informal resources, and clearly defines implementation responsibilities.

• Monitors the delivery of services and evaluates member outcomes and makes revisions as indicated. Follow up on issues timely. Identify suspected abuse, neglect or exploitation and contact APS (Adult Protective Services) if necessary.

• Modifies the service plan based on the status of the member without disruption of services or threat to the consumer’s health and safety.

• Use risk-management mechanisms to address high-risk situations and special needs of consumers.

• Submit documentation daily or as per supervisor direction.

• Reviews and monitors direct services provider emergency procedures to protect the health and safety of the member. Makes appropriate referrals as needed.

• Collaborates with appropriate medical personnel regarding medically complex consumers.

• Ensures confidentiality according to all relevant laws and regulations. Maintains all HIPAA regulations.

• Maintains appropriate and adequate records to document activity in the performance of responsibility as a component of the service delivery system.

• Manages time with the fluctuation of member case load and receives/maintains all members as assigned.

• Participates in training of new case managers and as preceptor.

• Participates in all other job duties as requested and/or assigned by Case Management Supervisor or Back-Up Supervisor.

• Review of all CQI audits received and updates all findings within a 48-hour period. If findings are substandard for CM job performance, the updates are non-billable units.

• Participation in all training, in-services and continuing education as required by Director of Operations, Case Management Supervisor or Educator as assigned.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by the employee of this job. The employee may be requested to perform job-related tasks other than those stated in this description.

JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities)The minimum qualifications for Case Managers are:

• RN with one year paid professional experience with aging or disabled population and Certified Advantage Case Manager or

• LPN with one year paid professional experience with aging or disabled population and Certified Advantage Case Manager or

• Baccalaureate Degree and one year paid professional experience with aging or disabled population, performing duties which encompass the core functions of case management and a Certified Advantage Case Manager.

• Must be a licensed driver with an automobile that is insured in accordance with state or organization requirements and is in good working order.

• Speak fluent English, demonstrate excellent verbal and written communication skills.

• Requires time management skills due to an ever-changing case load fluctuation and member needs with an emphasis on communication, collaboration, and interpersonal skills. Requires intermediate computer skills using an office-based word processing system.

WORKING ENVIRONMENT

Job requires working in hot, cold, or wet surroundings, outdoors, rarely occurrences with or near chemicals, near radiation sources, with hazardous waste materials, wearing protective clothing/equipment, with exposure to blood and body fluids, and operating medical equipment. Local travel is required and must have access to reliable transportation

PHYSICAL REQUIREMENTS

Standing, walking, sitting, twisting, climbing, bending/reaching, driving, weights lifted or carried up to 10 pounds, weights pushed or pulled up to 10 pounds. Finger dexterity for writing & typing. Occasional driving for extended periods of time.

COMPENSATION

The position is an exempt position. Compensation consists of a base salary plus a minimum number of units submitted based upon written notification by Case Management Supervisor or Director of Operations. Unbillable units submitted should not surpass 5% of total units submitted for the week without prior notification and approval.

ACKNOWLEDGEMENT

I have read this job description and fully understand the requirements and notices set forth therein. I hereby accept the position and agree to perform the identified essential functions in a safe manner and in accordance with the Company’s established policies and procedures. I agree to request guidance from my Supervisor if I am unsure of how to interpret any policy.

I further understand that my employment is at-will and thereby understand that my employment may be terminated at-will either by the Company or myself, and that such termination can be made with or without notice.

This position consistently supports and promotes compliance with the Code of Conduct by maintaining the privacy and confidentiality of information, protecting the assets of the agency, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal, State, and local laws and regulations, accreditation, and licensure requirements (if applicable), and all policies and procedures.