Provides Care Management services to support Care Design NY’s model of care as well as OPWDD and NYSDOH’s regulatory requirements. The care manager is the person responsible for leading a care coordination team and overseeing all care coordination and care management supports and services to assigned participants. Responsibilities include, but are not limited to, assisting the member in developing, implementing, and monitoring person-centered service plans (Life Plans) using participant health risk assessments and other clinical, social, and functional information to meet members’ needs and preferences. Also, responsible for serving as the lead of the participant’s Interdisciplinary Team (IDT).
It is critical that the Care Manager understand and incorporate into their approach to their work the following driving forces behind Care Design New York’s organizational culture:
- Individuals and families are at the center of all we do.
- We work for individuals and families.
- We value what individuals and families have to say.
- We are focused on outcomes that meet individual needs.
- We will be strong advocates and protect individuals’ rights.Travel is primarily local during the business day.
Duties and Responsibilities
- Responsible for all care management duties and providing comprehensive care coordination including monitoring the Participant’s Life Plans according to each individual’s unique needs and circumstances.
- Applying a person-centered approach, the care manager is responsible for scheduling, leading and actively collaborating with the Participant and IDT to conduct meetings and assessments to ensure the development of a comprehensive Life Plan that reflects the person’s needs and desired life goals.
- Utilizing planning tools such as I AM, CQL POMs, the CAS/DDP2, the LOC, the Comprehensive Emergency Plan and other assessments as needed; such as the Environmental Assessment and Care Giver Adequacy Assessment
- Implement, update, and monitor Life Plans, and facilitate individualized Life Plan reviews and approval processes at a minimum of every six months or when a trigger event occurs.
- Ensure integration of all needed and preferred supports and services (i.e. medical, behavioral, social, habilitation, dental, psychosocial, and community-based and facility-based long-term supports and services, etc.).
- Communicate with IDT, physicians, and other providers at regular intervals to monitor and update Life Plan(s) and to advocate for participant needs and preferences.
- Provide education to participants, caregivers, circles of support, IDTs, and other stakeholders.
- Maintain participant Life Plan and health risk assessment information in secure system and meet all confidentiality requirements.
- Conduct in-person visits in accordance with OPWDD requirements.
- Flexibility in work schedule is required, with some evening and, or weekend hours as needed.
- Promote Care Design NYs mission and values.
- Utilize a person-centered approach supporting individual’s preferences and desires to promote reaching their highest level of independence.
- Maintain ongoing contact with the important people in a participant’s life, as appropriate.
- Ensure timely submission of all documentation (Life Plan, Progress notes etc.) in accordance with regulated time frames.
- Assist Individual to ensure maintenance of entitlements including recertifications. guardianship, informed decision making.
- Care Managers are expected to assist individuals with maintaining benefits such as Social Security, Supplemental Security Income (SSI), Medicaid and Medicare coverage and/or Food Stamps.
- Monitoring benefits for individuals whose representative payee is the agency operating their certified residence and assisting individuals with their benefits, when the individual does not have a representative payee or when the non-residential representative payee requests assistance.
- Assist individuals to resolve problems in living such as housing, utilities, judicial system and general safety.
- Responsible for advocating for and with an individual to ensure informed decision making, informed consent, and guardianship that is appropriately carried out.
- Meet all training requirements on time.
- Report abuse or neglect immediately when observed or reported.
- May be required to provide transportation for individuals based on their unique needs. (ie. Doctor’s appointments, planning meetings, etc.)
- Other duties as assigned.
- This description of duties and responsibilities is intended to indicate the kind of tasks required of the position. It does not limit or exclude other duties not mentioned here but required for the successful completion of the job.
- Care Managers should demonstrate the skills and ability to demonstrate a great level of diplomacy and discretion to effectively negotiate and resolve issues with minimal assistance.
- Skilled ability in positive, solution focused-problem solving, complaint resolution and consumer satisfaction.
- Strong work ethic – consistent record of reliability and trustworthiness.
- Proficiency in navigating through electronic record software programs.
- Excellent organizational, interpersonal and verbal and written communication skills required; ability to attend to detail, organize tasks/priorities and complete with accuracy.
- Critical thinking, creativity and flexibility with an ability to adapt to various and fast paced environments.
- Skilled in health-related computer applications.
- A high level of confidentiality is expected of an employee in this position.
Working Conditions & Physical Requirements
- This job operates in a professional office environment. This role routinely uses standard office equipment such as laptop, computers and smartphones.
- While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms.
- Must have visual acuity adequate to read correspondence, computer screen, forms; manual dexterity to operate keyboard; speaking and hearing ability sufficient to communicate by phone or in person at normal volume.
- May be required to vary hours, days, and work schedules depending upon overall needs of the organization.
- Ability to lift and carry materials up to 20 pounds.
- The physical demands described above are representative of those that must be met by an employee to successfully perform the primary duties of the job.
- The noise level in the work environment is usually moderate.
- Must convey detailed, important spoken or written instructions to others accurately.
- Must have ability to receive and understand detailed critical information through oral and/or written communication
Reasonable accommodations will be made to enable individuals with to perform the essential functions,