Complex Care Manager - Centralized Unit

Why Work at AbsoluteCare?

At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer.

We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.

We don’t stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works.

Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT2.

Job Summary

The Complex Care Manager (CCM) is a vital member of the Shared Services Support team, providing telephonic support to market teams on a temporary basis. Market assignments are based on business needs including growth, expansion, natural attrition and absences; hours may vary depending on needs, including evenings and weekends. The CCM is responsible for managing a caseload of members based on health instabilities, utilization, and healthcare spend. The role involves outreach and engagement of assigned members, conducting comprehensive assessments, developing person-centered care plans, and supporting members in achieving their health care goals through regular telephonic touchpoints supporting clinical interventions, education, motivational interviewing, self-management coaching, and complex case management services. The CCM coordinates services with community primary care providers, health plan programs, AbsoluteCare services, community resources, and specialists to meet the individual needs of members and achieve value-based outcomes.

Duties and Responsibilities

• Complete comprehensive assessment for each member on the assigned caseload.

• Develop, implement, and maintain person-centered care plans using SMART goals.

• Manage person-centered care plans and member contact in compliance with all agency requirements, internal protocols, and accreditation standards.

• Maintain up to date PCCPs in the electronic health record, including objective measures to track progress required to successfully track and complete treatment plan goals.

• Provide education with teach back regarding medical and behavioral conditions, symptoms, and treatment options.

• Utilize motivational interviewing and self-management coaching techniques to empower members.

• Coordinate complex case management services, including navigation of health plan benefits and community resources.

• Manage assigned caseload based on contact frequency requirements and utilization data.

• Proactively mitigate/resolve barriers to care to increase adherence to treatment plan.

• Collaborate with the ICT to update the team on member progress and needs and provide CCM recommendations for members to stabilize health and overcome barriers to social determinants of health.

• Collaborate with community primary care providers, health plan programs, AbsoluteCare services, and specialists to ensure seamless care coordination.

• Monitor and evaluate member progress, adjusting care plans as necessary to achieve desired outcomes.

• Maintain accurate and timely documentation of all member interactions and care plans.

• Meet established Key Performance Indicators.

• Assist members in accessing and engaging with services and resources.

• Actively participate in required meetings.

• Other duties as assigned to meet business needs.

• Maintain the security and privacy of all information that is owned by AbsoluteCare or maintained on behalf of the company’s patients, employees, and business partners.

• This position is primarily telephonic, with occasional in-person meetings as needed.

• The role requires flexibility to provide temporary assistance to various market teams across time zones.

Minimum Qualifications

• Licensed registered nurse in a compact state required, practicing and abiding by all laws, regulations, and requirements with willingness to acquire licensure in non-compact states.

• Preference given to qualified case managers with CCM credentials. CMGT-BC, CCTM, ACM or FAACM will be considered.

• 3+ years of experience in serving the needs of complex populations, including medically complex, trauma history, mental health conditions, substance abuse, and socioeconomic barriers in an office or community-based setting.

• UM and MCG standards a plus.

• Excellent computer skills including Microsoft Office Suite (Outlook, Excel, PowerPoint, Word) and electronic medical record documentation required.

• Excellent written and oral communication skills to interact with members, families, community stakeholders, and interdisciplinary team required.

• Ability to meet accreditation and quality standards including, but not limited to NCQA, PCMH, HEDIS through following defined procedures to assess, intervene and document interactions.

• Ability to work independently and exercise excellent clinical judgement.