Care Ally, RN Case Manager

Curana Health, Inc.•Many, LA

4d•Hybrid

About The Position

The Care Ally, Case Manager is a key member of the interdisciplinary care team (ICT), using a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options and services that address members’ health and social needs. The role serves as a liaison among members, their Responsible Parties and/or Power of Attorneys (RP/POAs), Advance Plan Provider/PCP, and Align Senior Care stakeholders. The position reports to the Supervisor of Case Management. The Care Ally conducts member health assessments, develops and monitors care plans and goals, provides education and health coaching, coordinates with care teams and providers, and helps members and their representatives access benefits, appointments, community resources, and other services. The role also supports member concerns and administrative needs, including grievances, utilization management, billing issues, and updates to contact information. This is a hybrid role requiring independent management and scheduling of field visits, documentation, deadlines, and follow-up. Candidates must have reliable transportation and be comfortable traveling to assigned facilities an average of two to three days per week, with the remaining time spent working from a home office.

Requirements

At least one year of clinical practice experience in case management, home health, critical care, medical/surgical, discharge planning, or concurrent review.
Proficiency with basic Microsoft Office applications, including Word, Excel, and Outlook, and ability to navigate multiple systems and perform keyboarding.
Meet one of the following credential requirements: an active, unrestricted RN or LPN license in the state where job duties are performed, or a Bachelor’s degree in social work (BSW).
Ability to work autonomously in a hybrid role, independently manage and schedule field visits, complete documentation, meet deadlines, and follow up consistently.
Reliable transportation and willingness to travel to assigned facilities an average of two to three days per week.

Nice To Haves

Case management certification.
Long-term care or nursing facility experience.
Master of Social Work (MSW) degree and social-work licensure.

Responsibilities

Execute strategies and goals set by the Align Senior Care Board of Directors, Senior Leadership Team, and Executive Director to manage and improve the overall member experience.
Contact plan members to conduct comprehensive health assessments, develop plans of care, and participate in facility interdisciplinary care team meetings.
Educate members, families, and/or caregivers about disease status and treatment, plan benefits, community resources, and available resource options.
Collaborate with interdisciplinary care team members and medical directors to facilitate appropriate member treatment.
Follow up with members as scheduled to assess progress toward goals.
Help members and/or caregivers develop health goals and identify interventions to achieve them.
Provide patient-centered interventions, including making and verifying appointments and supporting medication and care compliance.
Serve as front-line support for members and their RP/POAs, connecting members with their communities, care teams, and internal departments to address their needs.
Engage members and RP/POAs in person or by phone to provide education and assistance with plan benefits, specialist appointments, supplemental benefits and providers, immediate needs, and questions.
Communicate member health updates from the care team to RP/POAs.
Coordinate with the care team on non-urgent health or clinical questions.
Work with internal departments to resolve member grievances and utilization management and billing issues.
Update member and RP/POA contact information, including address, email, and phone number changes.
Support the Account Manager in identifying and securing contracts with preferred providers.
Help members, RP/POAs, and partner communities locate in-network providers and schedule or facilitate appointments.
At the request of a member or APP, coordinate home health and therapy visits, durable medical equipment orders, and use of supplemental benefits.
Monitor and, when needed, facilitate care team meetings with facility teams, members, responsible parties, and the APP/clinical team.
Ensure care team meetings are documented and documentation is transmitted to the plan.
Monitor care plan updates, facilitate APP and PCP input, and distribute care plans to care team members as needed.
Monitor midnight reports and community census to help identify member transitions to a hospital or another level of care.