AFC Care Manager

LifeStream Inc; Michigan; On-site; USD 50,000 - 61,000; Full time

Job summary

LifeStream, Inc. is seeking a social services professional to conduct on-site visits with AFC members and caregivers, coordinate referrals and preadmission assessments, and collaborate with MassHealth for authorization documentation.

The role involves gathering medical and psychosocial information, performing evaluations, and developing person-centered AFC Plans of Care with the multidisciplinary team. Strong communication and organizational skills are essential.

Qualifications

• Bachelor's degree required in Social Work, Human Services, Nursing, or related field.
• Experience working with older adults or individuals with disabilities.
• Knowledge of care coordination and community-based services.
• Strong communication, organizational, and interpersonal skills.

Responsibilities

• Conduct required on-site visits with AFC members and caregivers per service level and MassHealth regulations.
• Coordinate AFC referrals, intake activities, and preadmission assessments with the AFC RN and Director of Community and Family Services.
• Coordinate with MassHealth or PAO to obtain initial clinical assessments and required authorization documentation.
• Obtain and review medical, social, and psychosocial information to support AFC admission and ongoing service delivery.
• Obtain social history and conduct psychosocial evaluations per MassHealth requirements.
• Evaluate member's psychosocial status and placement appropriateness for AFC.
• Develop, implement, and review each member's AFC Plan of Care with the team and responsible parties.
• Ensure the Plan of Care reflects strengths, needs, goals and resources.
• Assist in developing measurable, person-centered goals and interventions addressing medical, social, emotional, and functional needs.
• Monitor Plan of Care implementation and address concerns needing follow-up or review.

Skills

Care coordination knowledge

Communication skills

Organizational skills

Multitasking with multiple cases

Education

Bachelor's degree in Social Work, Human Services, Nursing, or related field

Job description

Come join one of the area’s largest employers!

See everything going on at LifeStream on our Facebook and Instagram page

Schedule is: Mon-Fri 8a-4p

Salary starting at $55,000

LifeStream is an equal opportunity employer

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Conduct required on-site visits with each AFC member and caregiver at the qualified setting in accordance with the member's AFC service level and applicable MassHealth regulations.
• Coordinate AFC referrals, intake activities, and preadmission assessments in collaboration with the AFC Registered Nurse and Director of Community and Family Services.
• Coordinate with MassHealth or its designated Public Assessor Option (PAO), when applicable, to obtain initial clinical assessment results and required authorization documentation.
• Obtain and review available medical, social, and psychosocial information to support appropriate AFC admission and ongoing service delivery.
• Obtain a comprehensive social history and conduct psychosocial evaluations of all AFC members in accordance with MassHealth requirements.
• Conduct initial and ongoing evaluations of the member's psychosocial status and appropriateness of the AFC placement.
• Participate in the development, implementation, and ongoing review of each member's AFC Plan of Care in collaboration with the member or responsible party, AFC Registered Nurse, caregiver, and other designated members of the multidisciplinary team.
• Ensure that the Plan of Care reflects the member's strengths, preferences, identified needs, goals, desired outcomes, and available community resources.
• Assist in developing measurable, person-centered goals and interventions that address the member's medical, social, emotional, and functional needs.
• Monitor implementation of the Plan of Care and identify concerns or changes requiring follow-up or multidisciplinary review.

Education/Experience:

• Bachelor's degree in Social Work, Human Services, Nursing, or a related field.
• Experience working with older adults or individuals with disabilities.
• Knowledge of care coordination and community-based services.
• Strong communication, organizational, and interpersonal skills.
• Ability to work independently and manage multiple cases.

QUALIFICATIONS AND REQUIREMENTS: To perform this job successfully, an individual must perform each essential duty satisfactorily. The requirements below represent knowledge, skill, and/or ability. Reasonable accommodation may be provided to enable individuals with disabilities to perform essential functions.

• Maintenance of an acceptable CORI
• Negative Drug Screening
• Valid driver’s license
• Use of personal vehicle for work purposes

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.