Clinical - LTSS Care Navigator

Job Description : Position Purpose :

Assists in developing assessing and coordinating holistic care management activities to enable quality costeffective healthcare outcomes. May develop or assist with developing personalized service care plans / service plans for longterm care members and educates members and their families / caregivers on services and benefits available to meet member needs.

Education / Experience :

Requires a Bachelors degree and 1 year of related experience.

Or equivalent experience acquired through accomplishments of applicable knowledge duties scope and skill reflective of the level of this position.

For Iowa Plan Only : A bachelor s degree with 30 semester hours or equivalent quarter hours in a human services field (including but not limited to psychology social work mental health counseling marriage and family therapy nursing education occupational therapy and recreational therapy) and at least one year of experience in the delivery of services to the population groups that the person is hired as a case manager or case management supervisor to serve; or An Iowa license to practice as a registered nurse and at least three years of experience in the delivery of services to the population group the person is hired as a case manager or case management supervisor to serve .

For Illinois Plan Only : In addition to the requirements above the employee working on

Physically Disabled / Elderly

Candidate must meet one of the 3 following criteria :

1. RN licensed in Illinois.

2. Bachelor or Master s Degree prepared in human services related field. Bachelor s degree in Human Services related field defined as : Child Family and Community Services Early Child Development Guidance and Counseling Home Economics Child and Family Services Human Development Counseling Human Service Administration Human Services Master of Divinity Pastoral Care Pastoral Counseling Psychiatric Nursing Psychiatry Psychology Public Administration Rehabilitation Counseling Social Science Social Services / Social Work or Sociology.

3. LPN with one (1) year experience in conducting comprehensive assessments and provision of formal service for the elderly

Brain Injury / HIV / AIDS

Candidate must meet one of the 3 following criteria :

1. A Registered Nurse (RN) licensed in Illinois and a bachelor s degree in nursing social work social sciences or counseling or four (4) years of case management experience

2. Certified or Licensed social worker with Bachelor s degree in either social work social sciences or counseling or a Masters of social work

3. Unlicensed social worker : minimum of bachelor s degree in social work social sciences or counseling

In addition to meeting one of the above criteria must have experience working with :

Addictive and dysfunctional family systems

Racial and ethnic minorities

Homosexuals and bisexuals

Persons with AIDS and

Substance abusers

• Evaluates the needs of the member the resources available and recommends and / or facilitates the plan for the best outcome

Assists with developing ongoing longterm care plans / service plans and works to identify providers specialist and / or community resources needed for longterm care

Coordinates as appropriate between the member and / or family / caregivers and the care provider team to ensure identified services are accessible to members

Provides resource support to members and their families / caregivers for various needs (e.g. employment housing participant direction independent living justice foster care) based on service assessment and plans

Monitors care plans / service plans member status and outcomes as appropriate and provides recommendations to care plan / service plan based on identified member needs

Interacts with longterm care healthcare providers and partners as appropriate to ensure member needs are met

Collects documents and maintains longterm care member information and care management activities to ensure compliance with current state federal and thirdparty payer regulators

May perform onsite visits to assess members needs and collaborates with providers or resources as appropriate

Provides and / or facilitates education to longterm care members and their families / caregivers on procedures healthcare provider instructions service options referrals and healthcare benefits

Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for longterm care members in a costeffective manner

Performs other duties as assigned

Complies with all policies and standards

Additional Sills :