Clinical Case Manager Long Term Services & Support RN | LCSW | Delaware

Amerihealth Caritas•,

About The Position

The Clinical Case Manager supports members eligible for Long Term Services and Supports (LTSS) under DSHP Plus LTSS in Sussex County, with possible statewide travel. The role helps members obtain needed services and contributes to the LTSS case management process through telephonic and face-to-face assessments, identification and coordination of member needs, and management of physical health, behavioral health, social services, and LTSS needs. The position completes annual Level of Care Redeterminations for home- and community-based members, including clinical review of continued program eligibility. It also provides clinical support to non-licensed case managers and may serve as a secondary case manager during an acute episode. The Clinical Case Manager conducts initial and ongoing assessments, develops care plans, initiates and monitors services, and facilitates person-centered planning. The role coordinates access to covered and non-covered medical and community supports, informs members about LTSS assessments, care planning, service options, and member rights, and assists with complaints, grievances, and DHS Fair Hearings. Additional duties include monitoring urgent services, critical incidents, care transitions, and worklists in Jiva, as well as supporting LTSS and DSNP members with comprehensive assessments, medication reconciliation, follow-up, and discharge planning. Travel of up to 75% is required. For remote or hybrid work, a reliable high-speed internet connection of at least 50 Mbps download and 5 Mbps upload is required.

Requirements

Delaware-licensed RN or LCSW.
Valid driver's license.
Knowledge of the home and community-based service system and how to access and arrange services.
Ability to provide informed advocacy.
Ability to interact with members face to face.
Ability to interact professionally with health care professionals.
Ability to travel up to 75%.

Responsibilities

Conduct annual or more frequent Level of Care reevaluations in accordance with DSHP Plus LTSS requirements.
Provide clinical support to non-licensed case managers as needed.
Conduct condition-specific assessments for members with chronic conditions, provide education, and conduct routine follow-up.
Perform initial clinical assessments of new members, develop care plans, and initiate services.
Facilitate person-centered planning team meetings to coordinate care and services.
Identify, coordinate, and help participants access needed LTSS, covered services, and non-covered medical, social, housing, educational, and other services and supports.
Provide information to participants and monitor authorized services and supports.
Inform participants about required LTSS needs assessments, the care plan process, service alternatives, and service delivery options.
Inform participants of their rights and responsibilities and assist with complaint, grievance, and DHS Fair Hearing processes.
Collect information about participant preferences, strengths, and goals for care plan development.
Conduct comprehensive needs assessments annually or more frequently as required.
Review and act on Jiva worklists, including monitoring new members.
Authorize urgent services when needed.
Monitor critical incident reporting and documentation, and recommend or take action with other corporate entities as required.
Conduct liaison activities with the Physical Health Care Coordination program.
Work with LTSS and DSNP members on comprehensive assessments, care plans, medication reconciliation, monitoring follow-up and progress, and discharge planning and transitions of care.
Travel up to 75%, including possible statewide travel.
Perform case management responsibilities based on business needs.