Source Case Manager

DEPARTMENT: Health programs Department

ACCOUNTABILITY: Reports to SOURCE Program Manager

STATUS: Exempt, Full-time- TBD schedule

JOB SUMMARY

Provides comprehensive case management services for a caseload of 75+ members with complex health, long-term care, and social service needs. Develops, implements, and monitors person-centered care plans in collaboration with members, families, caregivers, healthcare providers, and community partners. Conducts ongoing assessments through regular phone and in-home visits to evaluate needs, coordinate services, and ensure care plan goals are achieved. Serves as a liaison among clients, providers, and community agencies to facilitate access to resources, resolve concerns, and maintain continuity of care. Monitors service utilization, program compliance, and quality outcomes while maintaining accurate documentation and adherence to regulatory requirements, HIPAA standards, and agency policies. Participates in multidisciplinary care team meetings, supports eligibility and appeals processes, and advocates for member well-being, independence, and access to appropriate services. Serves large geographic areas which may include parts of one large county and/or many small counties. Travel involved.

DUTIES AND RESPONSIBILITIES

Essential Functions

• Manages a minimum caseload of 75 members/clients.

• Develops, implements, monitors, and updates comprehensive, person-centered care plans in collaboration with the client, family, caregivers, physicians, and service providers.

• Meets standards of promptness for new admission contacts, monthly phone contacts, in-home visits, and 90-day reassessments, documenting all activities within the designated data management system.

• Conducts monthly telephone contacts and face-to-face visits every 90 days to assess needs, monitor service effectiveness, and ensure care plan goals are being met.

• Acts as a liaison between members/clients, families, providers, physicians, and community partners to resolve concerns, address non-compliance issues, and coordinate services.

• Creates and adjusts service orders as necessary and troubleshoots billing concerns.

• Brokers and coordinates services as needed to support the implementation of the person-centered care plan.

• Arranges and coordinates community-based services and other support resources as appropriate.

• Communicates and collaborates with all agencies, providers, and organizations involved in the member's/client's care to ensure continuity and quality of services.

• Participates in multidisciplinary case conferences with nursing staff, medical directors, supervisors, and service providers to review care plans, hospitalizations, levels of care, areas of non-compliance, and ongoing needs.

• Maintains knowledge of applicable state regulations, program requirements, policies, and procedures governing service delivery.

• Reviews and monitors service utilization and costs to ensure compliance with program guidelines and established funding limitations.

• Oversees service delivery to verify that members/clients receive appropriate, effective, and person-centered care.

• Maintains accurate, complete, and timely documentation in accordance with agency and program requirements.

• Reports suspected abuse, neglect, or exploitation to appropriate agencies, including LTCO, APS, OIG, ORS, CPS, or other regulatory entities, as required.

• Communicates with eligibility and benefits agencies regarding program eligibility, renewals, and related matters.

• Assists members/clients with appeals and hearings, including the preparation and submission of required documentation and records.

• Collaborates with hospitals, home health agencies, nursing facilities, social workers, community organizations, and other stakeholders to support member/client well-being.

• Attends required network meetings, trainings, quarterly meetings, team meetings, and other program-related educational opportunities.

• Maintains current program manuals, policies, and reference materials as required.

• Adheres to all HIPAA regulations and confidentiality requirements to ensure the privacy and security of member/client information.

• Performs other duties as assigned