Description
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
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.
Qualifications
Required
Active, current, unrestricted RN, LMHC, LCDP, LCSW or LICSW license in RI in good standing (Consideration will be given to individuals without current RI license. Must provide documentation confirming application within 24 hours of offer)
Minimum of two (2) years care management, behavioral health, or community health experience
PC based software programs - intermediate level of proficiency
Strong organizational and interpersonal skills
Customer service orientation
Ability to work independently and prioritize activities
Must have access to reliable transportation. If using personal vehicle, must have active driver's license and auto insurance
Preferred
Managed Care experience
Certified Care Manager
Demonstrated experience working with Medicare, Medicaid, and commercial products
Bachelors degree
Masters degree
Bilingual
Behavioral Health and/or Substance use expertise
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.