Case Manager

Job Title: AccessCare Case Manager
Reports to: Regional Project Manager or Community Project Manager

I. GENERAL PURPOSE OF POSITION:

AccessCare is part of Community Care of NC. A program that builds on Carolina Access by assisting local providers to develop managed care delivery systems that coordinate a continuum of care with processes to influence cost and quality of care.The program is sponsored by the Division of Medical Assistance (DMA) and the North Carolina Foundation for Alternative Health Programs, Inc, and is funded, in part by the Kate B. Reynolds Health Care Trust.

AccessCare Case Managers (ACM) will work with local providers to develop community-based managed care networks and infrastructure that will be able to meet the health care needs of the Medicaid population, while providing the State with greater budget predictability.

The primary purpose of the AccessCare Case Manager is to assist in assessing, planning, implementing, coordinating, monitoring and evaluating the options and services required to meet the needs of the Medicaid Carolina Access population, using communication and available resources to promote quality, cost-effective outcomes.

II. RESPONSIBILITIES AND ACCOUNTABILITIES:

• The ACM will work in concert with the Primary Care Provider (PCP) and the community to coordinate a full continuum of health care services considering the patient's unique social and cultural dynamics.
• Act as a liaison between the PCP, AccessCare, local Health Department (HD), Department of Social Services (DSS), and local hospitals by arranging health care services in concert with the PCP
• Work with PCP and other network providers in assuring appropriate client management
• Build and maintain relationships with community service providers through collaboration, networking and educating at community functions
• Collaborates with team members to innovatively consolidate work, solve problems, and/or reduce costs
• Assist in maintaining accurate practice database on the Access II project
• Develop and implement a tracking and monitoring process to aid in assisting the client access to necessary health and support services
• Review data submitted from DMA in terms of case report and cost benefit analysis
• Identify “at risk” enrollees
• Develop and implement individualized care plans for those clients identified at greatest risk
• Provide direct follow-up and outreach services to “at risk” clients
• Educate clients and families on the importance of medical care management and the proper method to access care in the Carolina Access program
• Coordinate, develop and provide health care education programs and training that are applicable to the client and families' needs
• Work with the AccessCare program to implement disease centered initiatives
• Audit charts and compile data to support the disease centered initiatives
• Works to resolve conflict constructively; seeks guidance regarding conflict resolution when necessary
• Perform other duties as required

III. NATURE AND SCOPE OF THE POSITION

A. Supervision Duties: Not Applicable

B. Organizational Relationships

C. Scope of Responsibilities

• Budget Responsibilities: Not applicable.
• Confidential Information: Responsible for maintaining confidentiality of all client and family information.
• Equipment used: Computer with various software programs such as Internet, Excel, and word processor, computer printer, digital pager, telephone, personal automobile, fax machine, copier, calculator, and paper shredder.

Make occasional significant decisions within the standards of the position. Is generally guided by established policy and only unusual questions or problems are referred to a superior.

V. KNOWLEDGE/SKILLS REQUIRED

Education/Experience: RN (BSN preferred), or LPN. Graduation from a state accredited school of professional nursing. A minimum of 1 year acute nursing care experience and one year of community based nursing experience is required. Two years of care management experience are highly preferred. An ADN or LPN will be considered if education and experience commensurate. Must possess a valid NC Driver's License and a valid NC Nursing License.

Medical Social Worker with bachelor's degree from an accredited school of social work and two years of community medical social work experience. Experience in managed care is highly preferred. Must possess a valid NC Driver's License.

OR

Health Professional with commensurate experience in the health field. A minimum of 3 years in the health related field required, with community experience preferred. Must possess a valid NC Driver's License.

• Excellent communication skills both orally and in writing
• Considerable knowledge of care management principles
• Knowledge of government, private organizations and community resources
• Skill in establishing rapport with a client and applying techniques of assessing psychosocial, behavioral, and psychological aspects of a client's problem
• Knowledge of and compliance with federal and state regulations applicable to the position
• Analytical skills necessary as independent decisions and problem solving are required
• Strong organizational and computer skills required including various office software and Internet

VII. WORKING CONDITIONS

Physical Demands - The job environment is primarily a medical office environment although patient home visits may be required. Exposure to general office and household conditions as well as communicable diseases could occur. Routinely there may be some minor physical inconveniences or discomfort in the work setting. A moderate amount of traveling/driving is required, as well as sitting for moderate periods of time. There is occasional lifting of 20-30 pounds necessary to complete a task.

Work Environment - Time will be spent visiting PCP offices, other health care providers, hospital, DSS, community organizations, and homes of clients and their families. “Hands on” clinical treatment is not permitted when performing AccessCare duties. Frequent changes are expected on a daily basis; therefore, flexibility and adaptability are needed. Evening and weekend work may be required. Travel may be part of a daily routine based on client needs and establishing community networks within the provider service area. Local travel in your personal automobile could vary between 25% - 75%. Attendance at occasional regional office meetings in the Morrisville area will be required.