Description

Meets with new members in joining ChooseHome, a continuing care at home program, to begin the relationship with the new member and answer any questions about the program. Educates callers through the Senior Care Navigation program and advises callers as to appropriate and available resources, helping them make educated choices. Make initial decisions regarding eligibility for utilization of services or choose the best fitting vendor, if Riverside is unable to serve.
Completes member assessments on an as needed, no less than annually, which includes an assessment of functional and cognitive changes. Utilizes provided tools to complete assessments. Acts as role model and mentor in assessment skills, consistently identifies subtle changes, follows through on client and intake.
Maintains comprehensive records for all members to ensure appropriate utilization and accurate claim requests. Reports monthly on the cumulative utilization by members and referrals to and from Senior Care Navigation. Monitor provision of service to ensure client’s needs are met and regulations have been followed.
Based on provided member assessments, coordinates and ensures the provision of services to meet member needs, as well as Senior Care Navigation coordination. Independently interprets the baseline of member’s care and changes level of care based on assessment and in conjunction with physician/provider notes as well as family communication and direct observation/home assessment. Apply clinical conditions of patient to requirements of contract utilization in Choose Home.
Discusses, creates and documents advanced care plans for members.

Requirements

Education:

Bachelors Degree, Degree of study in Nursing/Social Work, or Related (Preferred)

Experience

1 year of experience in a customer service-oriented role with an older adult population (Required)
1 year in Healthcare/Medical - Case Manager (Required)