Assess applicants in the community for eligibility and enrollment in our Managed Long Term Care program. Provides overview of program's benefits to applicant, family member(s), care giver(s). Complete medical assessment of applicant and develop personalized plans of care. Complete Reassessment as needed of our members in the Managed Long term Care Program.
Department: Long Term Care
Reports: Senior Manager, Long Term Care Clinical Programs
- Conduct home visit(s) to educate applicant, family and/or applicant's caregiver(s) on program benefits and design.
- Identify applicant's health needs and complete medical assessment of applicant.
- Utilize WellCare designated criteria along with clinical knowledge to develop personalized plan of care.
- Initiate direct communication with health care providers involved in the care of the applicant to obtain complete and accurate information needed to complete plan of care.
- Negotiate appropriate care plan based on health assessments with health care providers, member and caregiver.
- Collect information concerning eligibility, provider status, benefit coverage, and coordination of benefits.
- Input visit and assessment data into systems.
- Adhere to all HIPPA standards and confidentiality requirements.
- Performs other duties as assigned.
- Valid Drivers license may be required
- Required An Associate's Degree in Nursing
- Preferred A Bachelor's Degree in Nursing or related field
- Required 4 years of experience in A clinical acute care setting, preferably in home health and/or geriatrics.
- Required Other Current case management experience
- Preferred Other Public speaking and health education experience
Licenses and Certifications:
- Intermediate Knowledge of healthcare delivery
- Intermediate Ability to effectively present information and respond to questions from families, members, and providers
- Intermediate Ability to effectively present information and respond to questions from peers and management
- Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
- Intermediate Ability to influence internal and external constituents
- Intermediate Ability to represent the company with external constituents
- Intermediate Demonstrated customer service skills
- Intermediate Ability to create, review and interpret treatment plans
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated written communication skills
A license in one of the following is required:
- Required Licensed Registered Nurse (RN)
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Word
- Required Intermediate Healthcare Management Systems (Generic)
- Preferred Other Bilingual skills