Licensed Care Manager Macon

PruittHealth • Griffin, GA

3d • Onsite

About The Position

The Licensed Care Manager is responsible for screening referrals, coordinating the admission process, and managing services with providers. This role also involves billing reconciliation, community outreach to referral sources, and participating in team meetings to present patient assessments and care plans. The position requires regular home visits, PCP visits, and tracking of hospitalizations and variances. The Care Manager will coordinate with various healthcare agencies and providers, reevaluate member needs, and ensure service effectiveness. Additionally, the role involves administrative tasks such as completing mileage and time sheets, arranging transportation, and participating in internal audits. Training new hires and participating in on-call rotations are also key responsibilities. Communication with regulatory agencies like APS and CPS is essential.

Requirements

• Bachelor's degree in business related field.
• Must have a valid driver’s license and automobile insurance liability
• Graduate of a state approved accredited nursing school
• Certified in Basic Cardiopulmonary Resuscitation
• Minimum of five (5) years of nursing experience.

Nice To Haves

• Hospice or SOURCE care preferred.

Responsibilities

• Markets their area for awareness of SOURCE and PRN meetings with new PCPs.
• Completes all new admission paperwork for signed forms and in-home assessments.
• Participates in team meetings with Medical Director each week and presents all new admits, annual assessments, hospitalizations, Home Health admits and discharges, repeat variances, People with potential for discharge and actual discharges and situations threatening someone’s health or functional status.
• Completes quarterly homes visits and quarterly PCP visits with all requirements for each completed.
• Completes variances at any given time when a care path goal is not met. Must list the variance plan of actions and must have follow up to resolution or a repeat variance with a new plan outlined.
• Tracks all hospital/ER visits by completing paperwork, requesting records and communicating with hospitals.
• Coordinates with outpatient therapy centers, home health agencies, healthcare centers (if short term), and rehab by working with their staff and completing skilled care track form.
• Makes PRN contacts and home visits if needed to assess member needs.
• Reevaluates member needs for service, level of service and evaluates service effectiveness.
• Uses own vehicle for travel. Completes mileage and time sheets for reimbursement.
• Arranges transportation as required.
• Is available for internal record audits as requested.
• Completes annual reassessments in member’s homes.
• Reviews medicine for appropriateness.
• Attends trainings when required.
• Trains new hires as needed.
• Is available for on-call rotation as designated by CMS referrals.
• Communicates with regulatory and DFACS agencies for APS and CPS referrals.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level