The Care Manager provides services within the Care Management programs, including Health Home Care Comprehensive Care Management, HCBS Basic Plan Support, and State Paid Care Management services. The core responsibility of the Care Manager is to oversee and coordinate access to services for people with intellectual and developmental disabilities.
Requirements
- Deliver person-centered care management services in compliance with regulatory standards and in alignment with the agency’s quality management plan, policies, and standard operating procedures.
- Responsible for the completion of a comprehensive assessment/reassessment process.
- Identify gaps in service provision and make referrals when appropriate.
- Advocate on the member’s behalf, to reach their identified goals and live a meaningful and quality life.
- Develop, implement, and monitor member Life Plans within required timeframes, by leading an interdisciplinary team planning process, with the person at the center.
- Complete all required service documentation with stated timeframes.
- Ensure all billing critical documentation is present and valid prior to the submission of any billable service documentation.
- Maintain the member’s continued eligibility for care management through the completion of an annual Level of Care (Re)Determination, ensuring OPWDD eligibility is maintained, and enrolling in the Home and Community Based (HCBS) waiver.
- Identify and access benefits and entitlements (Medicaid, Social Security, SNAP, etc.) when a member is eligible.
- Ensure existing benefits and other entitlements are maintained.
- Ensure a current and accurate information sharing consent is present within the electronic health record and updated as necessary when changes occur or are requested by the member and/or representative.
- Coordinates and provides access to high quality healthcare services, inclusive of medical, behavioral health, specialized services.
- Provides regular communication, monitoring, and action oriented follow up on critical and acute healthcare needs.
- Identifies, coordinates, and provides access to preventative and health promotion services as needed.
- Coordinates transitional care inclusive of appropriate follow up from inpatient to other settings, discharge planning, facilitating transfers within the healthcare system, residential settings and aging out of childhood services to adult services.
- Use health information technology in the delivery of care management services, included but not limited to the use of the electronic health records and programs to facilitate telehealth services for members.
- Maintain a thorough and accurate electronic health record for all assigned members.
- Attend department/team meetings, trainings, supervisions, etc. as scheduled and in accordance with agency practice and policy.
- Complete all required trainings within required timeframes.
- Travel throughout the designated service area to meet with members as needed in alignment with regulatory standards and to ensure identified needs are met.
- Travel is required to meet with providers, members of the interdisciplinary team, and accompany members where indicated to necessary appointments.
- Identify and follow all incident reporting guidelines and procedures, ensuring the immediate safety of the member.
- Maintains confidentiality in accordance with HIPAA and privacy practices.
- Adheres to all policies and standard operating procedures for the delivery of comprehensive care management and ancillary functions of the Care Manager.
- Adheres to and upholds ACA/NY’s Code of Conduct.
- Perform other duties, as assigned.
