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Field Care Manager RN-LTC

Works with Care Coordination MVP Team members to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member.

Coordinates, monitors and ensures that appropriate and timely primary, acute and long-term care services are provided to members across the continuum of care.

Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member.

Coordinates the care and services of selected member populations across the continuum of illness.

Promotes effective utilization and monitors health care resources.

Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes.

Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc.

while collaborating with management to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member. 
 

Reports To: Dir, Field Care Management

Department: Health Services-M'Caid

Position Location: Jacksonville, FL.

Essential Functions:


* Evaluates members for case management services and determines appropriate level of care coordination/ management services for member.


* Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services.


* Acts as a primary case manager for members identified as Complex as defined by Case Management Program Description.


* Develops and monitors members plan of care, to include progress toward meeting established goals and self-management activities.


* Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status.

Assess the options for care including use of benefits and community resources to update the care plan.


* Supervises and/or acts as a resource for non-clinical staff (i.e., Service Coordinators and Field Social Workers).


* Act as liaison and member advocate between the member/family, physician and facilities/agencies.


* Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines.


* Coordinates community resources, with emphasis on medical, behavioral, and social services.

Applies case management standards, maintains HIPAA standards and confidentiality of protected health information and reports critical incidents and information regarding quality of care issues.


* Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.


* Meets with clients in their homes, work-sites, physician’s or hospital to provide management of services.


* Adapts to chan...




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