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 | |||||
| Story Behind the Need Business Group & Key Projects | |||||
| Carolina Complete Health Managed Medicaid Our team has a strong reputation for innovation, reliability, and collaboration. We are known for delivering high-quality results, maintaining a positive work culture, and consistently exceeding client expectations. The ability to manage complex cases effectively. Key skills include excellent communication, problem-solving, and team-building capabilities. | ||||
| Typical Day in the Role | |||||
| Monday-Friday 8-5 Remote- will be provided with monitor, laptop computer, 2 monitors, cellphone, and safety location tracker for visits. Day to day duties include completing F2F and telephonic assessment with members to determine ADL assistance needs. Care coordination between member and care partners to address member s medical care needs. Key skills include excellent communication, problem-solving, and physical assessment skills. Must possess strong interpersonal skills and the ability to build positive relationships with team members, leaders, and members. The candidate should demonstrate empathy, patience, and respect for diverse perspectives. Behaviors like active listening, adaptability, and a collaborative mindset are crucial for fostering a supportive and cohesive team environment. This ensures that everyone feels valued and heard. | ||||
| Compelling Story & Candidate Value Proposition | |||||
| This role is appealing because it offers the opportunity to make a meaningful impact on WC members in their home community. In this role, team members function independently connecting members to needed services but have access to mentors to assist in their development in the role. My leadership style is centered on open communication and empowering team members to ensure they feel valued and equipped to succeed in their roles. | ||||
| Candidate Requirements | |||||
| Education/Certification | Required: Bachelor's degree | Preferred: RN | |||
| Licensure | Required: NC RN licensure | Preferred: RN | |||
| Must haves: NC RN licensure; valid driver s license, personal vehicle. Nice to haves: CCM certification Disqualifiers: Expired licensure, no vehicle. Residence outside of NC/Region 5 (Bladen, Brunswick, Columbus, Cumberland, Harnett, Hoke, Lee, Montgomery, Moore, New Hanover, Pender, Richmond, Robeson, Sampson, Scotland counties) Performance indicators: | ||||
| 1 | Comfortable traveling within a 2 hour radius to members homes on a weekly basis to complete assessments to identify care needs | |||
| 2 | Have reliable transportation and valid driver s license | ||||
| 3 | Experience in assisting people in navigating the health system, i.e., comfortable talking to care partners about needed services such as DME, scheduling appointments, etc. | ||||
| Candidate Review & Selection | |||||
| Projected HM Candidate Review Date: | 1-2 days post shortlisting | |||
| Number and Type of Interviews: | |||||
| Extra Interview Prep for Candidate: | |||||
| Required Testing or Assessment (by Vendor): | |||||
| Manager Communication Preferences & Next Steps | |||||
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