Case Manager Jobs

About The Position

Requirements

• 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.
• 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 professional qualification paths: an active, unrestricted RN or LPN license in the state where job duties are performed; or a bachelor’s degree in social work (BSW).

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 established 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 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.
• 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 carrying out medication and care compliance initiatives.
• Serve as front-line support for members and their RP/POAs, connecting them with their 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 plan benefits, appointments, supplemental benefits, 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 address member grievances and utilization management or 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 involving 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.