ADvantage Case Manager

Description

Responsible for the development, implementation, and monitoring of a comprehensive plan of care on an individualized basis for ADvantage members to ensure that the member able to remain in their home, safe and independent as possible.

RESPONSIBILITIES:

1. Understands and adheres to established agency policies and procedures.
2. Develop and implement a comprehensive plan of care on an individual basis for ADvantage members and monthly follow-ups to ensure that outcomes are being met and resources are being identified. Adjust members plan of care as needed.
3. Coordinates assessment/reassessment and admission of members to the ADvantage Program.
4. Coordinate services with home care agencies to assist CM in establishing and maintaining plan of care through the initial, 6-month, reassessment and other times as directed by CM when member needs nursing services.
5. Seeks out all appropriate resources that member is eligible for, before using ADvantage Medicaid funds.
6. Review and evaluate service plans, goals, addendums, and service plan reviews to ensure services are meeting Members needs.
7. Keeps CM Supervisor updated on status of members and areas of concern.
8. Completes follow-up visits and telephone calls on each member per agency guidelines.
9. Maintains current record on member of any changes in status or needs. Submit updated information to designated person by designated times to ensure compliance with agency, ADvantage Program standards, and state licensure requirements.
10. Ensure that Supervisory Aide Visits, RN Evaluations, and Case Management follow-up monitoring are completed per ADvantage Administration Unit standards.
11. Develop professional working relationships with all the organizational representatives, providers, and families to ensure continuity of care for members.
12. Keep home care agency updated on needs or changes in service plan for member.
13. Submit completed paperwork within allotted time frames to ensure continuity of care and for supervisor to review and approve.
    • Case Management Billing Sheets must be submitted within 24-hours of service date.
    • Reassessments must be submitted no later than 21-days prior to ADvantage due date.
    • Initial service plans must be submitted within 8-business days upon receiving member.
14. Must bill weekly debit amounts in accordance with the Case Manager Billing Scale.
15. Other duties as assigned.

Qualifications

QUALIFICATIONS:

1. Must be an LPN or RN with one year of paid professional experience or have a Baccalaureate degree with one year of paid professional experience with the aging or disabled population.
2. Must be a certified Case Manager or will be required to complete one week of orientation including job shadowing a certified Case Manager before attending certification training
3. Have valid drivers license, auto insurance, and dependable transportation.
4. Have a sympathetic attitude toward the care of the sick and elderly.
5. Ability to follow directions, read and write.
6. Maturity and ability to deal effectively with the demands of the job.