Independent Living Systems
Clinical Care Manager
Independent Living Systems, Miami, Florida, us, 33222
ABOUT US
Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary
The Clinical Care Manager is responsible for clinical care management services of members enrolled through ILS’ client health plans to promote effective education, self-management support, and timely healthcare delivery to achieve optimal quality and positive outcomes. The Clinical Care Manager behaves in a professional manner, and consistently demonstrates and promotes the values of respect, honesty, care and dignity for the members as well as all other team members involved in the servicing of ILS’ clients. The Clinical Care Manager is involved in care management services inclusive of Special Needs Members (SNP), Seniors and Persons with Disabilities (SPD), private insurance, Medicare, and state’s Medicaid programs. The Clinical Care Manager will be responsible for the collaborative development and initiation of individualized care plans using member health risk assessment, health plan reported utilization data, and other clinical, social and functional data. The Clinical Care Manager will be responsible for initial implementation of identified interventions based on care plans developed.
Essential Functions
Conducts initial review of member’s data provided by health plan, compare against member’s self-reported data obtained through the Health Risk Assessment (HRA) process.
Interacts telephonically with members to initiate member’s individualized care plan using the available data.
Prioritizes members according to intensity, need, and required follow-up.
Conducts periodic holistic assessments.
Evaluates the effectiveness of the care plan in meeting established care goals; revises the plan as needed to reflect changing needs, problems, and goals.
Identifies and effectively utilizes health plan benefits and community resources to meet the needs of members and caregivers.
Makes appropriate referrals to other programs to address the member’s needs.
Promotes member self-management and empowers members/caregivers to achieve maximum levels of wellness and independence.
Provides ongoing development of care plans using the problems, goals and interventions methodology for assigned case load.
Serves as a liaison to providers, members, and caregivers for coordination of services.
Provides member education during care management activities.
Maintains accurate and timely documentation in the electronic care management system.
Works in conjunction with others on the team and promotes collaborative teamwork.
Maintains a working knowledge of and adheres to applicable federal/state regulations including but not limited to, laws related to patient confidentiality, release of information, and HIPAA.
Performs all duties and responsibilities in accordance with the Nurse Practice Act and in accordance with basic principles and guidelines of professional nursing.
Education and Experience
Health licensed issue by the State of Florida – RN or LPN
1+ years in managed healthcare
1+ years in case management or disease management.
Required Skills
Basic patient education and self-management training.
Basic computer skills including data entry (database), MS Word.
Strong communication skills including verbal and writing skills.
Valid Driver’s License
Ability to work independently, while collaborating with other team members.
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Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary
The Clinical Care Manager is responsible for clinical care management services of members enrolled through ILS’ client health plans to promote effective education, self-management support, and timely healthcare delivery to achieve optimal quality and positive outcomes. The Clinical Care Manager behaves in a professional manner, and consistently demonstrates and promotes the values of respect, honesty, care and dignity for the members as well as all other team members involved in the servicing of ILS’ clients. The Clinical Care Manager is involved in care management services inclusive of Special Needs Members (SNP), Seniors and Persons with Disabilities (SPD), private insurance, Medicare, and state’s Medicaid programs. The Clinical Care Manager will be responsible for the collaborative development and initiation of individualized care plans using member health risk assessment, health plan reported utilization data, and other clinical, social and functional data. The Clinical Care Manager will be responsible for initial implementation of identified interventions based on care plans developed.
Essential Functions
Conducts initial review of member’s data provided by health plan, compare against member’s self-reported data obtained through the Health Risk Assessment (HRA) process.
Interacts telephonically with members to initiate member’s individualized care plan using the available data.
Prioritizes members according to intensity, need, and required follow-up.
Conducts periodic holistic assessments.
Evaluates the effectiveness of the care plan in meeting established care goals; revises the plan as needed to reflect changing needs, problems, and goals.
Identifies and effectively utilizes health plan benefits and community resources to meet the needs of members and caregivers.
Makes appropriate referrals to other programs to address the member’s needs.
Promotes member self-management and empowers members/caregivers to achieve maximum levels of wellness and independence.
Provides ongoing development of care plans using the problems, goals and interventions methodology for assigned case load.
Serves as a liaison to providers, members, and caregivers for coordination of services.
Provides member education during care management activities.
Maintains accurate and timely documentation in the electronic care management system.
Works in conjunction with others on the team and promotes collaborative teamwork.
Maintains a working knowledge of and adheres to applicable federal/state regulations including but not limited to, laws related to patient confidentiality, release of information, and HIPAA.
Performs all duties and responsibilities in accordance with the Nurse Practice Act and in accordance with basic principles and guidelines of professional nursing.
Education and Experience
Health licensed issue by the State of Florida – RN or LPN
1+ years in managed healthcare
1+ years in case management or disease management.
Required Skills
Basic patient education and self-management training.
Basic computer skills including data entry (database), MS Word.
Strong communication skills including verbal and writing skills.
Valid Driver’s License
Ability to work independently, while collaborating with other team members.
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