The Field Care Coordinator 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 Care Coordinator behaves 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 Care Coordinator is involved in care management support services inclusive of the Elderly, Persons with Disabilities, and other waivers as part of the State’s Medicaid Programs. The Care Coordinator works to support the care management model including coordination with other ILS and health plan personnel and/or their partners, The Care Coordinator 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, and for the timely documentation of all coordination activities in eCare.
REQUIREMENTS FOR ALL POSITIONS
1.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.
2.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.
3.All employees are required to maintain confidentiality, protect privacy, comply with PHI regulations, and report violations.
POSITION RESPONSIBILITIES AND ACCOUNTABILITY
1.Contacts members within required timeframes and conducts assessments.
2.Follows policies on contacting members that are unable to be reached.
3.Prioritizes members according to intensity, need, and required follow-up. Schedules visits/contacts using the most efficient routing and time efficiency as possible.
4.Conducts comprehensive assessments utilizing eCare tools and incorporates other required Health Plan and/or State/Federal required assessments.
5.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.
6.Makes appropriate referrals to other programs to address the member’s needs in keeping with State cost maximums and/or utilizing plan benefits, incorporates natural supports and community resources as appropriate.
7.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.
8.Initiates and collaborates with the interdisciplinary care team (ICT) and facilitates case reviews as necessary.
9.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.
10.Identifies nursing facility residents who are candidates for repatriation and collaborate with the member, facility staff, and community agencies to transition members as possible.
11.Provides on-going communication and information to their manager.
12.Participates in orientation of new personnel.
13.Participates in regular team meetings and on-going education and training.
14.Works in conjunction with others on the team and promotes collaborative teamwork.
15.Adheres to organizational policies and procedures.
16.Maintains a working knowledge of, and adheres to applicable federal/state regulations including but not limited to, laws related to patient confidentiality, release of information, and HIPAA.
17.Maintains appropriate professional boundaries. Interacts in a manner which is professional, respectful, positive, helpful, and promotes trust.
18.Uses safe work practices. Promptly reports workplace and safety issues to supervisor.
19.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.
20.Maintains professional growth and development.
21.Facilitates transitions of care from hospital to home/LTC ensuring appropriate discharge planning and interventions to lessen risk of readmission.
22.Other duties as assigned.
Persons who are Elderly waiver
Care Coordinators must meet one (1) of the four (4) requirements:
Bachelor or Master in Social Work, or related field
Persons with Disabilities Waiver
Care Coordinators meet one (1) of the nine (9) following requirements:
1.Registered Nurse (RN) licensed in Illinois
2.Licensed Clinical Social Worker (LCSW)
3.Licensed Marriage and Family Therapist (LMFT)
4.Licensed Clinical Professional Counselor (LCPC)
5.Licensed Professional Counselor (LPC)
7.Doctor in Psychology (PsyD)
8.Bachelor or Master’s Degree prepared in human services related field
9.Licensed Practical Nurse (LPN)
Persons with Brain Injury Waiver
Care Coordinators must meet one (1) of the seven (7) following requirements:
1.Registered Nurse (RN) licensed in Illinois
2.Certified or Licensed social worker
3.Unlicensed social worker: minimum of a BA Degree in social work, social sciences, or counseling
4.Vocational specialist: certified rehabilitation counselor or at least three (3) years of experience working with people with disabilities
5.Licensed Clinical Professional Counselor (LCPC)
6.Licensed Professional Counselor (LPC)
7.Certified Case Manager (CCM)
Persons with HIV/AIDS Waiver
Care Coordinators must meet one (1) of the three (3) following requirements:
1.Registered Nurse (RN) licensed in Illinois and a BA Degree in social work, social sciences, or counseling, or four (4) years of case management experience
2.A social worker with a BA Degree in either social work, social sciences, or counseling (A BSE or MSW from a school accredited by any organization nationally recognized for the accreditation of schools of social work is preferred)
3.Individual with a BA Degree in a human services field with a minimum of five (5) years of case management experience.
In addition, it is mandatory that the Care Coordinator for enrollees within the Persons with HIV/AIDS Waiver have experience working with:
• Addictive and dysfunctional family systems
• Racial and ethnic minorities
• Homosexuals and bisexuals
• Persons with AIDS, and
• Substance abusers