Job Profile Summary 
Position Purpose: 
Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs. 
 
Education/Experience: 
Requires a Bachelor's degree and 2 – 4 years of related experience. 
 
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. 
 
License/Certification: 
For Iowa Only: Bachelor's degree with 30 semester hours or equivalent quarter hours in a human services field (including, but not limited to, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy) and at least two years of experience in the delivery of services to the population groups or current state's Registered Nurse (RN) license and at least four years of experience required 
For North Carolina Standard Plan: Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience; Prior experience with social work, geriatrics, gerontology, pediatrics, or human services. 
RN or LCSW required. 
 
For North Carolina Tailored Plan: Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience; Prior experience with social work, geriatrics, gerontology, pediatrics, or human services. 
RN or LCSW / LCSW-A preferred 
For Arkansas Total Care plan - This position is designated as safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment check (before hire and recurring), and a drug screen (at time of hire and recurring). Must reside in AR or border city. Travel: 5%. required 
 
Responsibilities 
Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome 
 
Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care 
 
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members 
 
Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans 
 
Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs 
 
Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met 
 
Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators 
 
May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners 
 
Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits 
 
Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner 
Performs other duties as assigned 
 
Complies with all policies and standards

Right to Hire - Case Manager

$28 - $31/hr

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