Case Manager Overview • The Case Manager role focuses on coordinating care and resources for members to achieve optimal clinical and resource outcomes. • Utilize clinical expertise to perform comprehensive assessments and collaborate on treatment plans and interventions. • Develop member-centric plans tailored to individual needs, health status, and support requirements. • Leverage community resources and funding sources to enhance care plans effectively. • Monitor and manage members’ progress, ensuring timely follow-ups and appropriate referrals. • Evaluate and facilitate care across various settings, including hospitals, rehabilitation units, and home care. • Document all aspects of care plans, from initial assessment to outcome evaluation. • Outreach to high-risk or high-cost cases, reviewing alternative treatment plans and assessing benefits. • Develop policies, procedures, and training materials to support internal and external stakeholders. Case Manager Key Responsibilities & Duties • Coordinate care and resources for members, ensuring optimal clinical outcomes and cost-effectiveness. • Perform comprehensive assessments to guide treatment plans and interventions. • Develop tailored care plans addressing members’ needs and barriers to achieving goals. • Utilize community resources and funding sources to enhance care plans. • Monitor member progress, adjusting plans and goals as necessary based on acuity. • Educate members on proactive interventions to improve outcomes and reduce expenses. • Document all aspects of care plans, ensuring accuracy and completeness. • Outreach to high-risk cases, assessing alternative treatment plans and benefits options. • Develop policies, procedures, and training materials to support case management practices. Case Manager Job Requirements • Bachelor of Science in Nursing (BSN) required; valid clinical license (NC or compact multi-state). • Minimum of 3 years of clinical and/or case management experience; 5 years preferred. • Specialty certifications such as CCM or CDCES may be required within 2 years. • Experience in behavioral health roles with applicable licensure is advantageous. • Strong knowledge of community resources and funding sources for care planning. • Proficient in developing and documenting comprehensive care plans and interventions. • Ability to evaluate medical necessity and appropriateness of services effectively. • Skilled in educating members on proactive interventions and positive outcomes. • Experience in policy development and training for case management practices.