Nurse Case Manager

Tri-County Office On Aging • Lansing, MI • 2h ago

Job Title: RN Supports Coordinator

Reports to: Nurse Supervisor

Work Location: Lansing, MI

Work Schedule: Monday - Friday, 8:00am to 5:00pm, 40 hours per week.

Compensation: 30.67/hour plus comprehensive benefits package including 100% employer paid pension, generous time off and 14 paid holidays.

General Responsibilities: Works with the elderly and the disabled who are at-risk of entering a nursing home by exploring their options and alternatives to institutional care. The Supports Coordinator Team, consisting of a Social Worker and RN, complete comprehensive assessments of participants, with a strong emphasis on Person Centered Planning and participant direction. Many of the specific duties listed below are mandated by the Michigan Department of Health & Human Services (MDHHS), Bureau of Aging, Community Living, and Supports (ACLS Bureau) Care Management Performance Standards

Essential Job Functions: (Reasonable accommodation will be provided, if necessary, for individuals with disabilities who can perform the essential job functions.)

Assists participants with securing Medicaid eligibility for Waiver services and monitoring for ongoing program eligibility.

Using the principles of Person-Centered Planning, the Care Management Team develops care plans with each participant, addressing and honoring the individual's specific needs and desires.

Conducts assessments as a member of a professional team. Assessments include an evaluation of the consumer's physical and mental health, functional capabilities and limitations, informal and formal support systems, physical environment, and financial resources. Completes periodic reassessments as a team or individual Supports Coordinator.

Arranges, coordinates, and monitors the services according to the person-centered plan, including those covered through the Medicaid Waiver and Bureau of Aging, Community Living, and Supports (ACLS Bureau).

Monitor the cost of Medicaid Waiver services and other formal services to maximize resources and stay within program parameters and goals.

Maintains accurate files with all the mandatory documents including ACLS Bureau and Medicaid Waiver documentation. Includes the use of a computer to enter information into program software and established database system.

Adhere to agency and program standards, and ACLS Bureau and MDHHS Supports Coordinator Performance Criteria. Participate in Quality Assurance activities.

Completes follow-up of all services arranged as determined in the person-centered care plan and adjusts as needed.

Provides advocacy on behalf of participants to secure services and benefits to which they are entitled and promotes participant freedom of choice.

Maintains shared caseload in conjunction with the RN or Social Work Supports Coordinator. As part of the teamwork practice, back-up is provided to the other Supports Coordinator.

Updates knowledge pertinent to the provision of services to the elderly and persons with disabilities through attendance at agency and community meetings and continuing education opportunities.

Establish and maintain working relationships with physicians, hospital discharge staff, nursing home staff, home health and other service providers.

Covers 24-hour on-call services as scheduled.

Examples of essential job functions listed do not include all tasks which may be required for this position. Duties and responsibilities may be added, deleted or modified at any time.

Knowledge, Skills & Abilities:

Commitment to the organization's missions and goals.

Computer skills sufficient to learn

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