Job Description

The Care Manager is a social services professional who provides psychosocial and counseling assistance for the Adult Foster Care (AFC) Program Members. The Care Manager reports directly to the Program Director and works with the Registered Nurse as part of the multidisciplinary professional team.

Qualifications:

- Bachelor’s Degree

- At least 2 year’s recent experience working with elderly or disabled persons.

- Strong communication and organizational skills.

- Ability to manage routine Member files, computer programs such as WORD, preferred.

- Must possess positive, enthusiastic attitude, good people skills, and professional appearance.

- Ability to work independently without constant supervision.

Responsibilities include:

- Conducting the initial and ongoing assessments of the AFC qualified setting

- Obtaining a social history and conducting a psychosocial assessment and evaluation

- Selecting, training, evaluating and supervising AFC Caregivers in conjunction with the registered nurse

- Participating in the development, implementation, and ongoing review of the AFC Plan of Care

- Conducting on-site visits with each Member at the qualified setting bimonthly (alternating with the bimonthly visit by the registered nurse) for Level I, and monthly for Level II Members

- Completing a Care Management Progress Note corresponding with each on-site visit or encounter and upon significant change

- Periodically reviewing the AFC Caregiver Log

- Assisting with obtaining information and accessing other health care and community services, if needed

- Reviewing and documenting the fire and safety procedures for the qualified setting

- Participating in discharge planning and implementation

- Reviewing at least annually the suitability of the qualified setting

- Assists in taking referrals as needed

- Verifies and assures AFC Caregiver time slips are signed and in the office on time

- Provides case management for AFC Members, including making referrals and arrangements for social services such as meal-on-wheels, transportation or other types of services.

- Provides education to the AFC Caregiver and member regarding emergency procedures for each building that AFC Members live in.

- Checks compliance of AFC Caregiver visits and checks documentation for accuracy and completeness.

- Makes required, scheduled home visits to AFC Members maintaining documentation in compliance with MassHealth regulations (see Face Sheet/Tracking Sheet for specific Visit Schedule).

- Maintains the AFC Member files in an orderly and complete fashion.

- Assures any housing, operational, social or other problems or issues of the AFC Members are addressed with the registered nurse and/or Program Director, as needed.

- Works with the Registered Nurse to make any needed changes to the AFC Member’s care plan.

- Ensures communication with AFC Members, family members, building-site staff and the AFC Caregiver, Registered Nurse and Program Director.

- Assists the Program Director in program outreach and marketing strategies, such as providing training seminars to new vendors.

- Maintains the Monthly Tracking Log for the AFC Program

- Assists in relaying messages to field staff, office staff, and community liaisons

- Performs other duties as assigned by the Program Director.

- Projects a concerned, professional attitude toward other personnel and external customers

- Works to develop a positive rapport with all staff members and community resources affiliated with the AFC Program

- Maintains high visibility and availability

- Reporting changes in member's condition to the member's AFC registered nurse.

Functional Abilities:

- Must be able to hear adequately with no more than an amplifier on the phone and to speak in a manner understood by most persons

- Must be able to read 12 point or larger type

- Must be able to stoop and bend effectively so as to be able to perform the above

listed essential job responsibilities

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