Overview
Care Manager – Pediatric Jobs in Manchester – New Hampshire – USA at BMC HealthNet Plan
Job Description
It’s an
exciting
time to join the Well Sense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
The Clinical Care Manager will perform as a Lead Care Manager responsible for the overall local integrated, holistic person-centered care management interventions for a member’s physical health, behavioral health (BH) and psychosocial support needs. The Clinical Care Manager will perform a variety of
diverse
and complex face-to- face and telephonic care management responsibilities. The Clinical Care Manager will organize, coordinate, and provide care coordination and care management services to at-risk and complex individuals through a member-centric, team-based approach.
The Clinical Care Manager facilitates and acts as the clinical link with the member’s Primary Care Team (PCT) which includes the Member, Caregiver(s), Primary Care Provider, community agency providers, pharmacists, social workers, and others involved with the Member’s care. The Care Manager will ensure the right care is provided in the right setting and at the right time by applying designated Level of Care criteria.
Our Investment in You:
Full-timeremote work
Competitive salaries
Excellent benefits
Key Functions/Responsibilities:
Manages a panel of high risk, medically, behaviorally and socially complex members
Administer Comprehensive Assessment, medication reconciliation, convene local care teams, develop, document, and implement integrated care plans Completes timely initial and on-going face-to-face comprehensive assessments with Member to evaluate member’s medical, behavioral health, functional status, and socioeconomic needs
Collaborates with Members of the local care team, including community/state agencies and internal staff
Facilitates meetings of theInterdisciplinaryCare Team (ICT) and serves as clinical subject matter expert and advocate for members
Develops and communicates an Individual Plan of Care (IPC) with member, caregiver(s), providers and other ICT members to address identified needs and ensures its implementation
Evaluates the effectiveness of the IPC and progress against goals Utilizes evidence-based guidelines to assist member in understanding their disease process and increase their capacity for self-management and optimal health
Utilizes data to ensure that clinical interventions result in improved clinical outcomes and appropriate utilization of services at the right time, right place, and right setting
Evaluates the effectiveness of alternative care services and ensures that cost effective,quality careis maintained according to standards
Provides pro-active management and follow up (via home visits, telephone, etc.) of the Member’s individualized plan of care (IPC)
Facilitates member and caregiver access to community resources relevant to the member’s needs
Documents clinical assessments and coordination of care in the medical management information system in a timely manner that meets regulatory and accreditation standards
Collaborates with discharge planning staff at contracted hospitals, proactively anticipating member needs and preferences
When designated as Lead Care Manager will lead discharge planning meetings, either in-person or telephonically
Provides culturally competent care coordination in keeping with the Member’s racia…
Title: Care Manager – Pediatric
Company: BMC HealthNet Plan
Location: Manchester – New Hampshire – USA
Category: Healthcare, Nursing
