Long-term Care Case Manager (RN)

Job Title : Care Coordinator

This position is a vital point of contact for members, focused on coordinating comprehensive care needs across various service systems and community supports. This is a full-time, community-based role necessitating regular travel within the designated territory in Delaware. Key responsibilities include engaging with members in their homes and providing case management services in nursing facility environments.

Essential Responsibilities :

• Conduct regular in-home and nursing facility visits, traveling to assess member needs face-to-face, complemented by follow-up calls as per state and national guidelines.
• Evaluate and coordinate care for individuals with chronic and complex health care, social service, and custodial needs in both nursing facilities and community settings.
• Facilitate the continuum of care that addresses physical, behavioral, and long-term service needs in a safe, cost-effective manner.
• Authorize LTSS services following thorough needs assessments, coordinating services and benefits appropriately.
• Support transitions between care settings, ensuring all member needs are met during shifts from acute care to home or community environments.
• Educate members and caregivers on healthcare needs, available resources, and service delivery options for optimal long-term care.
• Develop personalized care plans in collaboration with members and caregivers to align with specific needs and goals.
• Identify necessary resources for integrated care coordination, including referrals to disease management and complex case management programs.
• Collaborate with the member's healthcare team to ensure a comprehensive approach to care, maximizing safety and independence.
• Assist in developing contingency plans for gaps in service coverage.
• Ensure all authorized services are delivered as outlined in care plans.
• Assess the effectiveness of the service plan and make necessary adjustments aligned with policy and contractual obligations.
• Connect members with community resources to overcome barriers to optimal care.
• Document all case management services in the electronic health record accurately.
• Adhere to privacy laws, including HIPAA, and quality performance regulations.
• Perform additional tasks as needed.

Qualifications : Required :

Preferred :

Skills :

Travel Requirement : 25% - 50%

Physical and Environmental Demands :

Pay Range : Minimum : $57,700.00 - Maximum : $107,800.00. Base pay is determined by various factors including qualifications, experience, and contributions.

Highmark Health adheres to non-discrimination principles in hiring and provides accessibility options for all applicants.