Field Case Manager (RN)
The FCM provides case management functions for members enrolled through ILS’ client health plans to assist in promoting effective education, self-management support, and timely healthcare delivery to achieve optimal quality and positive outcomes. The FCM operates in a professional manner, and consistently demonstrates and promotes the values of respect, honesty, care and dignity for the members as well as all other team members involved in the servicing of ILS’ clients. The FCM is involved in care management support services inclusive of the elderly, persons with disabilities, and other waivers as part of the Medicare, and State’s Medicaid programs. The FCM works to support the case management model including coordination, management and follow-up with other ILS and health personnel and/or their partners. The FCM is responsible to ensure members are assessed per ILS policies and contractual requirements, that plans of care are developed with the member that are focused on their individual needs, that service plans reflect those needs, reflect other available medical/behavioral information and are entered into ILS’ proprietary software – eCare.
REQUIREMENTS FOR ALL POSITIONS
● All employees shall meet Compliance/Privacy Regulations and attend, at a minimum, one (1) hour of Compliance/Privacy educational training annually, as required by Independent Living Systems.
● All employees shall meet Risk Management Regulations and attend, at a minimum, one (1) hour of Risk Management education and training within the first thirty (30) days of employment and as required by law or Independent Living Systems and for a non-physician in clinical direct care delivery services, annually thereafter.
● All employees are required to maintain confidentiality, protect privacy, comply with PHI and HIPAA regulations, and report violations.
● Employees will attend training that reflects all State, Federal and Client requirements
POSITION RESPONSIBILITIES AND ACCOUNTABILITY
● Prioritizes members according to intensity, need, and required follow-up. Schedules visits/contacts using the most efficient routing and time sensitive manner as possible.
● Conducts comprehensive assessments utilizing eCare tools and incorporates other required Health Plan and/or State/Federal required assessments.
● Collaborates with member to develop member-centric plans of care that incorporates a service plan, back-up plan, and identification of problems, goals, and intervention.
● Makes appropriate referrals to other programs to address the member’s needs in keeping with State cost maximums and/or utilizing plan benefits, and incorporates natural supports and community resources as appropriate.
● Ensures that all care coordination activities and all communications are documented accurately and timely in eCare and all required Health Plan or State reporting required format to ensure that information will be available for report production, data collection, and data entry for care plan management.
● Initiates and collaborates with the interdisciplinary care team (ICT) and facilitates case reviews as necessary.
● Identifies members who are candidates for participant-directed/self-directed care and educates the member on the process, responsibility of overseeing their own care, completion of necessary paperwork to ensure appropriate hires (i.e. completion of PA packet with criminal background check), EVV (Electronic Visit Verification) responsibility and performance review.
● Identifies nursing facility residents who are candidates for repatriation and collaborate with the member, facility staff, and community agencies to transition members as soon as possible and to mitigate the risk of readmission.
● Provides on-going communication and information to their manager.
● Participates in orientation of new personnel.
● Participates in regular team meetings and on-going education and training.
● Works in conjunction with others on the team and promotes collaborative teamwork.
● Adheres to organizational policies and procedures.
● Adheres to all policies and standards of conduct as outlined in the Employee Handbook or related documentation
● Uses safe work practices. Promptly reports workplace and safety issues to supervisor.
● Serves as an advocate for their members, alert to any possibility of abuse, neglect and/or exploitation and any situation where fraud and abuse may occur; follows reporting guidelines.
● Maintains professional growth and development.
● Facilitates transitions of care from hospital to home/LTC ensuring appropriate discharge planning and interventions to mitigate risk of readmission.
● Other duties as assigned.
Independent Living Systems, LLC is a Drug Free Workplace employer with an existing drug free workplace policy.
Independent Living Systems, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Independent Living System, LLC complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities