Care Manager

PRIMARY PURPOSE

The Care Manager as a member of the Integrated Primary Care team plays a vital role in delivering patient care in accordance with LCH&Ds philosophy of partnership with patients. The Care Manager coordinates care based on the members healthcare needs and goals and follows up with the appropriate supports to attain those goals.

ESSENTIAL FUNCTIONS

Daily responsibilities include:

• Coordinate the of Plan of Care to achieve treatment goals and optimum healthcare outcomes for patients with chronic disease identified as high risk or other special populations.

This may include but is not limited to:

1. Teaching and support
2. Assist in establishing and monitoring progress towards Patient SelfManagement Goals
3. Assist in establishing and monitoring progress towards Patient Functional Lifestyle Goals
4. Identifying and assisting to overcome barriers in patient care
5. Facilitates Team Based Care
6. Review and management of ED and Hospitalization usage
7. Assist with Transition of Care
8. Provide medication reconciliation and review as necessary
9. Referral follow up and support

• Provide resources and services aimed at improving access to identified healthcare needs.
• Facilitate the necessary outside referrals which may include mental health or community services.
• Identify high risk members including specific populations and high hospital/ED utilization patients
• Conduct assessments such as PHQ and SBIRT on high risk members and use that information to set goals and implement plans based on social and clinical needs.
• Collaborate with other healthcare professionals within and outside of LCH&D.
• Utilize motivational interviewing skills to help encourage members to make medically necessary changes.
• Follow up with members until goals and outcomes are met which may require appointments phone calls and face to face or one on one evaluation.
• Function in accordance to Quality related programs including NCQA/PCMH CPC and CQI plan
• Demonstrate competence in all areas of assigned job responsibilities.
• Must maintain accurate records.
• Comply with HIPAA guidelines as all times
• Must maintain infection control standards at all times per organization policy.
• Demonstrate clinical competence.
• Must have knowledge of the LCH&D Continuous Quality Improvement Plan.
• Deliver care and services in accordance with the organizations philosophy of partnership with patients and integration of the organizations values of Respect Quality Compassion and Hope.
• Provide input and recommendations to enhance the growth and success of the organization.
• Make every attempt to meet daily goals and objectives as defined by the organization.
• Assume all other reasonable duties and responsibilities as directed by the organizations leadership.
• It is also the responsibility of every employee to ensure that executive management is made aware of any issues that could negatively impact the organization or its relationships with patients and the community. Also to report any and all violations and infractions against the organizations vision mission and values.

PUBLIC AND PROFESSIONAL ACTIVITES

• Travel between sites is required.
• Attend relevant professional activities such as organization sponsored events as needed.
• Attend trainings and seminars as directed.
• Attend meetings as directed.

COMPETENCIES

• Effective Communication
• Accountability
• Customer Service
• Organizational Awareness
• Emotional Intelligence

PHYSICAL DEMANDS

• A considerable amount of time will be spent working face to face with patients.
• Moderate use of computer and telephone.
• Some lifting of supplies and equipment up to 50 lbs.
• 25 walking or standing 75 sitting at a desk.
• Category I re: exposure to blood bodily fluids and communicable diseases.

EDUCATION AND CERTIFICATION REQUIREMENTS

• Bachelors Degree in Social Work Psychology or Nursing

SKILL AND EXPERIENCE REQUIREMENTS

• Minimum of two years of experience preferably in a community health setting is preferred.
• Must have knowledge of care management principles.
• Motivational Interviewing Training preferred.
• Strong computer skills with proficiencies in Outlook Word PowerPoint and Excel.
• Experience working with patient assessment tool i.e. SBIRT PHQ and CAGE.
• Must have strong organizational skills.
• Ability to maintain a calm and professional demeanor and communicate enthusiastically with patients.
• Ability to be responsive in working with a culturallydiverse patient population.
• Must have excellent communication skills with the ability to master a therapeutic communication approach.
• Ability to independently coordinate multiple tasks.
• Ability to work cooperatively with others.
• Must have valid drivers license and satisfactory driving record.
• Bilingual Spanish speaking is a plus.

BENEFITS

• Excellent Training and Orientation Program
• Paid Holidays
• Generous Paid Time Off (PTO)
• Health Dental and Vision Insurance
• Prescription Coverage
• Employer Paid Life Insurance
• Employer Paid Short and LongTerm Disability
• 401(k) Retirement Plan
• Giving back outreach and true advocacy to the patient community we serve.

Lorain County Health & Dentistry (LCH&D) is an Equal Opportunity Employer and is committed to adhering to employment practices in accordance with the EEOC.

LCH&D will ensure that all persons with disabilities are provided reasonable accommodations for the hiring process. If an accommodation is needed please contact the LCH&D Human Resources Department at