Manager Care Job Description

Manager Care Job Description

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Manager care provides supportive clinical documentation regarding appropriate level of care in Utilization Management documentation system- Outpatient Observation vs.

Manager Care Duties & Responsibilities

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

Sample responsibilities for this position include:

Responsible for clinical decisions related to beneficiaries seeking access to their benefits for Mental Health or Substance Abuse Services for all levels of care using established criteria, guidelines and policies
Applying Beacon criteria consistently to manage risk and urgent situations to deliver services consistently across client organizations and individual situations
Facilitate clinical policies implementation and maintenance, assess training and development needs for, and identify clinical resources and tools to improve program effectiveness and quality
Provide case management services in the office and via home visits that promote high quality, efficient and cost effective care
Serve as the point of contact for Disability Support Services when the Coordinator for DSS/SRR is engaged in a Title IX process
Examples of CM activities may include educating newly diagnosed patients about the disease and treatments
Complete telephone assessments and referrals
Coordinates with other Care Managers within VO within other facilities/agencies to ensure that patient comprehensive treatment needs are met
Analyzes specific utilization problems
Completes telephone assessments and referrals

Manager Care Qualifications

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

Licensing or Certifications for Manager Care

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

Education for Manager Care

Typically a job would require a certain level of education.

Employers hiring for the manager care 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 Manager Care

Desired skills for manager care include:

Coding and DRG assignment process
Resources
Levels of care
Observation status
Utilization Review
Utilization management
Medicaid
Clinical standards and outcomes
Funding
Services

Desired experience for manager care includes:

Manages initiatives, driving stakeholder and/or cross-functional
Local travel to the client provider offices will be required
Eligible on date of hire
Flexible Benefits Plan
HIV Insurance
Partnership Pension Plan

Manager Care Examples

1

Manager Care Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of manager care. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for manager care
  • Meet daily with Medical Director to review all TOC patients to ensure appropriate care and to ensure that clinic is obtaining Medicare payment for transition of care services
  • Act as the practice’s leading source of knowledge on medical neighborhood resources and their policies and business practices
  • Assist members and providers who call to understand treatment options and available services, explanation of benefits
  • Facilitate and coordinate the appropriate services and supports to meet the needs of enrollees, particularly high risk populations
  • Direct members to self-management tools and resources and support in their use
  • Consults with Beacon’s Physician Advisors (PA) when requests for services do not meet medical necessity criteria
  • Provides information to members and providers regarding mental health and substance abuse benefits and community treatment resources when appropriate
  • Assess patients care management needs via patient intake assessments
  • Conducting case conferences for development of care management plans for target patient populations in collaboration with primary care physician and other care team members and ancillary providers
  • Implementing specific care coordination activities or interventions to achieve the goals set by the Primary Care, Quality and Care Management teams
Qualifications for manager care
  • HealthQuest Wellness Program
  • Experience in TAY, older adults with MH/SA conditions, SMI, SUD, co-occurring disorders (MH with SUD, IDD or physical health)
  • Re-verification will take place no less than every 3 years.Valid California State Clinical License required (RN, LCSW, MFT, LPCC, PhD or PsyD)
  • In states where appropriate, must maintain certifications (CNA or HHA)
  • Current license to practice professional nursing in the state of Pennsylvania required
  • Inpatient clinical nursing experience in an acute hospital setting with two (2) years experience in the population to which the individual is to be assigned required or 2 years relevant CM/UM experience in another healthcare setting
2

Manager Care Job Description

Job Description Example
Our innovative and growing company is hiring for a manager care. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for manager care
  • Performs systematic assessment and reassessment of patient and family/significant other considering clinical presentation, cultural and religious influences, individual experiences, available resources, environmental factors health behaviors and practices
  • Specific state specialty programs may require initial and annual training hours related to the area of specialty
  • Manage transitions of care
  • Maintain a spreadsheet to monitor and manage any new or existing transition of care patients
  • Provide initial treatment plan clinical reviews, concurrent treatment plan reviews, case consultations and determine level care based on medical necessity
  • Coordinating outpatient discharge planning with the practitioner to assure continuity of care
  • Verify member coverage and advise all parties involved of the implications for treatment
  • Provide input into the development of case management systems
  • Completes a comprehensive assessment of the medical, behavioral health and psychosocial needs of identified members and their families when delegated by the health plan through the ICM assessment process, enrollment and trigger reports, and other case identification sources, and establishing and implementing culturally competent care management plans to meet the needs of members
  • Completes face to face visits with members and their families within inpatient settings and/or their homes on an as needed basis
Qualifications for manager care
  • Excellent interpersonal skills and communication style
  • Ability to form positive, collaborative relationships with hospital staff, patients, families and post-acute providers
  • BSN Degree required.Valid NJ RN License and valid driver's license required
  • 2-4 years clinical patient care experience in acute care setting and/or chronic disease management required
  • Experience with standard office technology in a Window based environment preferred
  • Experience with standard office equipment (phone, fax, copy, machine, scanner, email/voicemail) preferred
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Manager Care Job Description

Job Description Example
Our innovative and growing company is hiring for a manager care. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for manager care
  • Provides transitional care services to members being discharged
  • Coordinate services for a caseload of approximately 55 clients
  • Provide Health Home services for Adults with medium or high acuity
  • Identify needs and coordinate services relevant to the Plan of Care
  • Provide education to individual concerning Health Home services, along with information concerning conditions being treated
  • Facilitate and coordinate the appropriate services and supports to meet the needs of members, particularly high risk populations
  • Directs members to self-management tools and resources and provides support of their use
  • Facilitates and coordinate the appropriate services and supports to meet the needs of enrollees, particularly high-risk populations
  • Directs members to self-management tools and resources and support in their use
  • Support data collection, quality assurance, process improvements, and ongoing training activities as requested by Health Home leadership
Qualifications for manager care
  • Valid NJ RN License and valid driver's license required
  • Collaborates with physicians regarding discharge planning
  • Refers to Social Work for complex discharge planning
  • Works closely with physicians and healthcare team to ensure the patient an appropriate plan of treatment and a safe transition to home
  • Performs on-call duties responsibly and other duties as assigned to include cross coverage for RN roles in Care Management Department
  • 1+ year of experience in care/case management
4

Manager Care Job Description

Job Description Example
Our company is searching for experienced candidates for the position of manager care. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for manager care
  • Interact with Physician Advisors and Utilization Review Clinicians to discuss clinical questions, authorizations, alternative treatment options and concerns regarding specific cases
  • Meet strict deadlines and established cycle times through effective prioritization and follow-up skills in order to provide excellent care management services to all members assigned to ICM caseload
  • Demonstrate knowledge about services and utilize creativity to consider how to meet member's needs
  • Manages members experiencing crisis episodes and facilitates coordination of care as needed
  • Demonstrates flexibility and creativity in the design of innovative and individualized care plans in order to achieve maximum effectiveness and optimal outcomes for members and their families
  • Participates in facility based treatment team meetings to support integrated efforts and collaboration with the health care team
  • Provides assistance, advocacy, and empowerment to members in efforts to achieve optimal health
  • Reports to each scheduled shift on time
  • Serves as a mentor to junior team members through leadership and guidance based on integrity, positive example and a sense of team cohesiveness
  • Assists team members and offers suggestions to improve processes, training, culture, or work environment
Qualifications for manager care
  • Familiarity with general office and computer products, and a familiarity with computer programs and technology
  • Experience in an educational context
  • Advanced computer skills, Minimum Required
  • Must have ability to interact effectively with a variety of people and situations at all levels of the organization, Minimum Required
  • Master's level or Associate for RN
  • Knowledge and experience in inpatient and/or outpatient setting
5

Manager Care Job Description

Job Description Example
Our innovative and growing company is hiring for a manager care. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for manager care
  • Help clients achieve wellness and autonomy and better understanding of how to use a variety of health services
  • Triage and manage members referred to Case Management identified as ICM who may be high risk, high utilizing, at significant clinical risk or under-utilizing services
  • Facilitate and coordinate the appropriate services and supports to meet the member’s perceived needs
  • Complete care 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
  • Utilize benefit structures and community-based resources to meet member's needs
  • Provide home health services for children at medium or high acuity
  • Provide education to family and child concerning home health services
  • Assist and advocate for families and children in the attainment and maintenance of public benefits, such as financial, educational, social, and community services
  • Maintain quality assurance systems to ensure that services are in place for clients and documentation is complete and up to date
  • Complete care 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
Qualifications for manager care
  • LCSW in the Commonwealth of Pennsylvania
  • Two to Three years of post-graduate clinical experience
  • Experience working in the managed care industry preferred
  • Clinical assessment & crisis intervention skills
  • Required must have or become IM-CANS certified within 30 days of hire/start and be re-certified annually
  • Required intermediate knowledge and skills of MS Office including Excel, Word and Outlook Express

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