Position Summary: : Reporting to the Manager, Care Management, the Care Management Lead (CML) is responsible for supporting the clinical quality and compliance of care management services. The CML is the lead escalation point for clinical issue management and support. The CML works with teams to ensure compliance with documentation standards, required regulations, and best practices. The CML will collaborate with the Manager, Care Management and consult with additional clinical and compliance resources to ensure the effective onboarding and ongoing clinical support of care management teams to ensure delivery of high-quality services to consumers and caregivers. The CML creates and maintains a person-centered business culture that fosters commitment, continuous improvement, employee and caregiver engagement, and high performance.
What You Will Do: : Respond to requests from caregivers and consumers and communicate with team members regarding concerns or emerging issues Track consumer risk and work with care teams to adjust the plan of care (POC) as appropriate Manage the case conference process, facilitating case review as well as discussion of risk mitigation strategies and follow-up Resolve and respond to complaints or grievances expressed by consumers or caregivers or their stakeholders Drive effective utilization of established best practices and protocols across the team, ensuring compliance with contractual obligations and NCQA accreditation requirements; observe virtual/home visits with care management team members and review documentation for quality Coach and mentor care team members and identify individual or team training needs; provide training to new clinical team members and others as needed Assist the Manager, Care Management with incident investigations and reporting Ensure continuous survey and audit readiness, maintaining compliance with company policies and practices as well as federal/state/local regulations May supervise administrative staff Perform other projects and duties as assigned What You Will Bring: : Bachelor's degree or equivalent, preferably in a health care or social services discipline is required along with a minimum of 4-6 years of experience in case management and care planning for older adults with complex medical conditions and/or individuals with disabilities, preferably in a health care, long-term care, social service or community setting. An active RN license is preferred Demonstrated ability to coach and mentor others Working knowledge of case management systems, community service and delivery systems, and Microsoft Office suite Ability to travel (usually by automobile) within assigned geographic area; valid driver's license and automobile insurance is required Additional state-specific qualifications may be required About Us: : Careforth empowers thousands of family caregivers across the United States to confidently care for their loved ones at home. Everyday our team of trained nurses and care coaches engage in real conversations with caregivers, personally and via our proprietary digital collaboration app, to provide emotional support, personal guidance, and connections to community resources. Headquartered in Boston, Careforth's caregiver programs and services improve health outcomes, provide cost savings for those receiving care, and increase engagement and satisfaction for health plans and providers. Through it all Careforth supports family caregivers. At every turn.
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Careforth is an Equal Opportunity Employer*
DISCLAIMER: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.
*Careforth supports families with diverse backgrounds and as an equal opportunity employer, we seek employees who reflect the diverse population we serve. Careforth complies with all applicable laws concerning hiring and employment practices and is firmly committed to fostering and maintaining a workplace free from discrimination. We pledge to hire, train, and promote our employees without regard to race, religion, gender, gender identity, genetic information, age, national origin, sexual orientation, disability, veteran status, or any other category protected by applicable law.
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