Care Manager, LTSS

Description

1. Assessment & Planning
   • Conducts comprehensive assessments--including physical, psychosocial, and health literacy evaluations--and interprets relevant diagnostic data to identify member and family needs.
   • Applies critical thinking skills to analyze complex cases and determine underlying causes contributing to high costs. Uses these insights to inform individualized transition/treatment plans and address gaps in care delivery.
   • Partners with and empowers the member to develop an actionable care plan that helps prevent avoidable utilization.
2. Collaboration & Education
   • Assesses educational needs of members and families, ensuring clear and sufficient information is provided.
   • Facilitate effective communication and collaboration with interdisciplinary healthcare teams, including the member, their support person(s), other family members and external stakeholders to develop, implement, and evaluate individualized care plans, and to address systemic challenges in member care.
3. Care Coordination and Delivery
   • Coordinates a multi-disciplinary team to include but not limited to member's PCP, specialists, the member, caregivers, and other members of the healthcare team to ensure timely access to appropriate medical care, behavioral health care, and services
   • Coordinates and monitors activities among internal departments, external community agencies.
4. Quality Improvement & Leadership
   • Engages in quality improvement initiatives, supports leadership in system-level improvements, analyzes data for program enhancement, and mentors' colleagues to promote best practices.
5. Advocacy & Documentation
   • Advocates for members and families across the healthcare continuum and ensures thorough documentation of all care activities.
6. Performs all other miscellaneous responsibilities and duties as assigned or directed

#LI-Hybrid

Qualifications

1. Three years of relevant healthcare or clinical experience; or equivalent combination of education and experience.
2. Demonstrates thorough expertise in care transitions with little supervision required.
3. Possesses strong documentation and research abilities, can analyze information, make decisions, and communicate effectively both verbally and in writing.
4. Displays interpersonal skills, resolves conflicts, and acts with integrity.
5. Highly organized, able to multitask independently, fostering adaptability and teamwork.
6. Performs well in a fast-paced setting and readily adapts to changes.
7. Delivers outstanding customer service to both internal and external clients.
8. Utilizes excellent analytical and critical thinking to evaluate medical necessity and the suitability of patient services and treatment individually.
9. Safeguards patient privacy in accordance with Federal (HIPAA), organizational, and departmental regulations.
10. Clearly communicates with providers and health care teams while building collaborative relationships.
11. Intermediate working knowledge in Microsoft Office applications, including but not limited to Word, Outlook, and PowerPoint.
12. Experience with electronic medical records such as EPIC and HHIE.
13. Healthcare Professional license in the State of Hawaii*
    • *(upon hire, proof of licensure to be provided by employee to Human Resources as well as a signed "Clinical Affirmation Statement for RN/LSW" form if applicable)
14. Reliable transportation to perform in person (Face to Face) meetings or in alternative settings.