Care Manager Job Description

Care Manager Job Description

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Care manager provides community outreach to schools, local law enforcement agencies, and allied agencies regarding available resources for families and gives community presentations.

Care Manager Duties & Responsibilities

To write an effective care manager job description, begin by listing detailed duties, responsibilities and expectations. We have included care manager job description templates that you can modify and use.

Sample responsibilities for this position include:

Once members have been enrolled, conduct, convene, and lead treatment planning/care coordination meetings in community with collaterals
Recommend and arrange discharge plans, aftercare referrals, and community resources when members have an inpatient psychiatric admission
Assists patients with accessing a full range of medical, behavioral health, chemical dependency, psychosocial, and community services including referral to self-help groups and faith based organizations
Assist patients with accessing a full range of medical, psychosocial, and community services
Consulting and collaborating with other external agencies and community resources to provides support services
Complete UAS and other relevant screening and assessment tools in the member’s home
Ensure continuity of care for newly enrolled members
Identify and prioritize the member’s needs and preferences, develop quantifiable goals and desired outcomes and promote the member’s ability to self-manage to the greatest extent possible
Develop, implement and monitor the Person Centered Service Plan, assisting members in obtaining reasonable accommodations when appropriate
Manage case load, including risk stratification of members, monitoring reassessment needs and facilitating transitions of care settings

Care Manager Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Care Manager

List any licenses or certifications required by the position: CPR, CCM, CMS, CCP

Education for Care Manager

Typically a job would require a certain level of education.

Employers hiring for the care manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Nursing, Health, Education, Health Care, Substance Abuse, Social Work, Healthcare, Social Sciences, Human Services, Management

Skills for Care Manager

Desired skills for care manager include:

Healthcare delivery
Community
State and federal laws and resources
Community resources
Community health and social service agencies and additional community resources
Medicare
Managed Care
Utilizes accurate computer databases and documentation systems
Various reimbursement criteria and documentation necessary for reimbursement
Appropriate clinical goal expectations/outcomes for identified population

Desired experience for care manager includes:

Serve as the primary point of member contact
As the lead of the interdisciplinary team, facilitate the activities and communication within an interdisciplinary team of providers, vendors, facilities, discharge planners, field nurses, social workers, care coordinators, and member/caregivers to effectively manage care plans and transitions of care settings
Maintain timely, complete and accurate documentation using both hard copy and technology based solutions in compliance with policies and procedures
Gather and summarize data for reports
Support initiatives of the Quality Assessment and Performance Improvement Committee
Conduct PRI assessments

Care Manager Examples

1

Care Manager Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of care manager. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for care manager
  • RN, licensure as a professional
  • Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply VBH-PA criteria and renders authorization decisions
  • Carries a caseload consistent with contract expectations
  • Participate in meetings, as needed, to discuss feedback from providers/members regarding the continuum of care
  • Obtains required Care Management enrollment consents
  • Complete ongoing assessments
  • Meet client contact requirements
  • Function as a patient advocate
  • Meet care management documentation
  • Promote wellness and prevention
Qualifications for care manager
  • Responsible for initiating contact with a designated minimum number of assigned members
  • Implements the comprehensive plan of care
  • Coordinates with other Care Managers within the organization within other facilities/agencies to ensure that patient comprehensive treatment needs are met
  • Master’s Degree in a health-related field and licensed as health professional is preferred
  • Good organizational skills and ability to maintain client files, charts and test results
  • Have either a current, valid, unrestricted independent license in behavioral health or nursing (RN) with proof on date of hire and practice within the scope of their licensure
2

Care Manager Job Description

Job Description Example
Our growing company is looking to fill the role of care manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for care manager
  • Educates nursing, medical and ancillary staff about care management role, relevant clinical criteria and resources available for patients, regulatory and managed care requirements
  • Communicates the outcome of chart review and managed care company telephonic review with the health care team as appropriate
  • Coordinating a wide range of self-management support and disease registry activities for assigned patient population
  • Coordinating the process by which the patient obtains needed care
  • Partners with patient and family to develop short and long term goals for self-management of chronic conditions
  • Provides ongoing monitoring of patient involvement, participation and compliance with treatment plan and goals
  • Determines timely connection to appropriate care and outreach to insure engagement to mental health and substance abuse treatment
  • Analyzes specific access problems
  • Utilizes rounds and case consultants with Clinical Supervisor, Peer Advisor for cases outside criteria or not processing
  • Carry a caseload of students referred by SRR or DSS
Qualifications for care manager
  • Computer skills to support documentation of patient care case finding
  • IPhone Apple store
  • Excellent communication skills, both verbal and written, and the demonstrated ability to relate effectively to behavioral health and medical treatment providers, Members and family members, and other professionals involved in the treatment of the Member
  • Part time, full time and per diem shifts
  • Some lifting and repositioning of patients
  • 3 years experience in securing wide range of benefits for low-income, at-risk populations who also may struggle with substance use/addiction, mental health issues, and complex chronic health conditions
3

Care Manager Job Description

Job Description Example
Our growing company is hiring for a care manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for care manager
  • Direct Assistant Care Manager and Community Liaison Worker in performing care management duties
  • Assist and advocate in the process of maintaining active Medicaid & entitlements provided through Department of Social Services, Social Security Administration and other community service providers
  • Collaborates with medical care managers, pharmacy staff and other community stakeholders to develop a comprehensive and integrated approach to care coordination
  • Makes timely referrals for community based services
  • Travels to secondary site locations, facility sites and/or community based health care provider sites as required by Beacon and/or health plan business needs
  • Create patient centered and culturally competent Individualized Care Plan (ICP) to include problem identification, goal-setting, interventions and expected outcomes
  • Provide health coaching and education to members related to health care conditions and treatment plans with a focus on medication and treatment adherence, appropriate use of emergency room, and navigation of the health care system
  • Collaborate with medical and social care managers and Pharmacy to develop a comprehensive and integrated approach to care coordination
  • Performs telephonic or paper case review and authorization determinations for certification of admissions into Behavioral Health or Substance Abuse treatment at any level of care
  • Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon’s medical necessity level of care criteria
Qualifications for care manager
  • Advocate for member’s needs to facilitate movement through systems both internal and external to the organization
  • 3 years experience in direct patient care is required
  • CPN Certification preferred
  • Skilled in the use of professional communication and presentation software
  • Must be licensed as a Registered Nurse
  • Minimum of Associate’s degree in Nursing required
4

Care Manager Job Description

Job Description Example
Our innovative and growing company is looking for a care manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for care manager
  • Complete care and utilization management activities in a timely manner and meet compliance requirements for the state Medicaid regulatory HSAG, Medicare NORC, NCQA, and Beacon Clinical Management department standard operating procedures
  • Utilizes rounds and case consultation with Clinical Supervisor/Manager/Director and Medical Director/Peer Advisor for cases outside criteria or not progressing
  • Refers cases to Peer Advisors that do not meet criteria for decisions of medical necessity
  • Coordinates with providers and other Care Managers to assure that patient comprehensive treatment needs are met and that there is continuity or patient care
  • Maintains departmental productivity and performance standards
  • Administer a comprehensive assessment and service plan
  • Document all case activity, including outreach, consent development and assessment, plan development, client progress and transition arrangements within 24-48 hours of encounter
  • Assist and advocate in the coordination of medical / behavioral care
  • Actively participate in interdepartmental team meetings to review progress, update POCs, and confirm continuing client eligibility
  • Conduct patient-centered consultations to include problem identification, goal-setting, interventions and expected outcomes
Qualifications for care manager
  • Develop collaborative relationships with providers to deliver appropriate and timely health care services
  • Case Manager certification or other National Utilization Management/Quality Assurance professional certification preferred
  • Screens and identifies patients who would benefit from home health services
  • Observation Care Manager conducts utilization review for patients with Observation level of care by applying InterQual criteria, nurse's impression that the inpatient medical necessity is appropriate based on Care Manager's expertise and critical thinking, and/or referral to Physician Advisor to determine appropriateness for change in level of care to inpatient
  • Interpersonal skills and a desire to build collaborative and consultative professional relationships with faculty, staff, students, and outside resources
  • Demonstrated intercultural capacity and investment in culturally responsive learning approaches, learning differences, and educational equity
5

Care Manager Job Description

Job Description Example
Our growing company is looking for a care manager. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for care manager
  • Coordinate trainings with child psychiatrists, primary care practices and behavioral health providers
  • In-state travel is required to primary care and behavioral health sites
  • Compiling demographic and clinical information to provide referrals and connect any member with appropriate providers or treatment facilities
  • Coordination with other Care Managers to assure that patient comprehensive treatment needs are met
  • Develop care plans after a complete review of claimant medical records received from long term care providers
  • Review insurance eligibility assessments
  • Provide chronically ill certifications and document claim records
  • Represent the Company in depositions
  • Assist claimants with modifications to care plan
  • Monitor daily, weekly, and monthly reports to ensure timely and appropriate handling of claims
Qualifications for care manager
  • Care Management or Utilization Management experience, Preferred
  • RN or LSW License required
  • Five years nursing experience with varied medical exposure and experience, required
  • Excellent communication and negotiation skills, both verbal and written, required
  • BSN or BSW degree from an accredited program required
  • Current State of Montana Registered Nurse License

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