Integrated Care Manager (44285)

The Integrated Care Manager (ICM) works collaboratively with the integrated care team to manage and coordinate care for a specific population of members whose needs represent high clinical and social risk in order to ensure quality and cost-effective member-centered care.

Duties and Responsibilities

Responsibilities include, but are not limited to the following:

• Practice care management within the scope of licensure.
• Utilizes care management principles and sound clinical judgment in coordinating care for a specific member population
• Performs intensive care management functions for identified individuals in order to promote quality, cost-effective outcomes, including but not limited to:
• Performing a comprehensive assessment which includes care planning activities including the development of interventions, short and long-term goals in collaboration with member, family, PCP, behavioral health professionals and other involved health care professionals and community agencies, as appropriate
• Communicate with providers to facilitate needed care
• Implements care plan, facilitates referrals, coordinates services, and resources and provides ongoing monitoring and re-evaluation of outcomes
• Continuous monitoring and evaluation of the care outcomes and identification of service gaps
• Regular review and revision of the plan of care in collaboration with the family and appropriate members of the health care team based on the outcomes and evaluative findings
• Off-site visits (such as but not limited to home, hospital or community health centers or other community agencies) as necessary or required
• Completes comprehensive documentation of all activities and contacts in Care Management software system
• Facilitates referrals and coordinates needed services
• Collaborates with team as necessary in identifying needed services and supports
• Communicates with ancillary departments, such as Provider Relations and Member Services, as necessary to meet individual needs of members and providers
• Meets department and regulatory standards for accuracy, proficiency, and documentation in order to communicate decisions and plan of care in an appropriate and timely manner
• Provides clinical oversight to community outreach and other team members, providing direct supervision of community outreach staff as appropriate regarding individual care status
• Serves as a clinical resource to respond to questions from various departments
• Provides cross-coverage as assigned
• Participates in outreach/marketing activities as needed and as appropriate
• Other duties as assigned
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents