Under the supervision of the Care Management (CM) Supervisor, the Care Manager I is responsible for completing the appropriate level of care management activities for Rocky Mountain Human Services (RMHS) clients. Care management activities will include but will not be limited to completing assessments, determining eligibility, monitoring provider services, coordinating services, developing care plans, delivering care management interventions, appropriate follow up activities and completing all documentation in the expected time frame. The Care Manager I will apply appropriate criteria, guidelines, regulations specific to the level of care and services required to meet the member/family goals and the organizational/contractual requirements. Care management functions may be performed for clients in a variety of settings including telephonic, in-person or in the community setting.
- Completes mandatory and needs based health assessments to identify client strengths, needs, concerns and preferences through interviewing, observing, and utilization of standardized tools.
- Establishes person centered goals and a plan of care with the client and their natural supports/family members.
- Provides care coordination services and interventions by referring, educating, negotiating, and mediating with the client and external providers of client services.
- Educates clients regarding various state plan benefits, programs, options and services.
- Monitors client status and satisfaction with services and makes adjustments to care plan as needed.
- Monitors the ongoing provision of and need for care by assessing the delivery and quality of services and interventions provided by external providers.
- Establishes professional and effective collaboration, communication, and coordination among all responsible parties of an individual members interdisciplinary health care team.
- As needed, attends client focused meetings (internal/external) to facilitate changes in services or collaborate in care.
- Maintains knowledge of regulations, policies, and procedures regarding current public assistance programs.
- Assists clients and providers in understanding the complaint, grievance and appeal process.
- Responsible for accurate and timely completion of all forms, reports, and documentation of care management activities.
- Maintains professional and ethical manner with all interactions and meets performance, quality, customer service, and coordination standards as assigned by the department management team.
- Participates in training and staff development opportunities. Actively participates in team meetings and communicates progress and barriers with Supervisor and/or Program Manager or Department Director.