Care Ally, RN Case Manager

Curana Health, Inc.•Gonzales, 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 meet 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 assessments, develops and monitors care plans, provides health coaching and benefit education, coordinates care and appointments, and supports members and RP/POAs with questions and service needs. The role works with facility teams, clinicians, internal departments, and community providers to address member needs, resolve issues, and support appropriate transitions and utilization of care.

Requirements

One year of clinical practice experience in at least one of these areas: case management, home health, critical care, medical/surgical, discharge planning, or concurrent review.
Proficiency with basic Microsoft Office skills, including Word, Excel, and Outlook; ability to navigate multiple systems and perform keyboarding.
Meet one of the following qualifications: 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.
Access to reliable transportation and comfort traveling to assigned facilities an average of two to three days per week, with remaining time spent working from a home office.

Nice To Haves

Case management certification.
Long-term care or nursing facility experience.
Master of Social Work (MSW) 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 facilities’ interdisciplinary care team meetings.
Educate members, families, and caregivers about disease status and treatment, plan benefits, community resources, and resource options.
Collaborate with interdisciplinary care team members and medical directors to facilitate appropriate treatment.
Follow up with members as scheduled to assess progress toward goals.
Communicate with members and/or caregivers to develop health goals and identify interventions to achieve them.
Provide patient-centered interventions, including making and verifying appointments and performing medication and care compliance initiatives.
Serve as front-line support for members and RP/POAs, connecting members, communities, care teams, and Align Senior Care internal departments.
Engage members and RP/POAs in person or by phone to provide education and assistance with 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 regarding non-urgent health or clinical questions.
Work with internal departments to resolve member grievances and utilization management- and billing-related issues.
Update member and RP/POA contact information, including address, email, and phone 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 a member’s or APP’s request, coordinate home health and therapy visits, order durable medical equipment, and assist with use of supplemental benefits.
Monitor and, when needed, facilitate care team meetings with facility teams, members, responsible parties, and the APP/clinical team.
Document care team meetings and transmit documentation 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 hospitals or other levels of care.