Specialized Care Manager

Key responsibilities

• Assessment and consumer engagement
• Establish timely contact with assigned consumers and their authorized representatives.
• Conduct comprehensive assessments to identify medical, functional, social, and environmental needs.
• Gather and maintain required documentation, including informed consent forms, assessments, and supporting records.
• Identify barriers to community transition and develop strategies to address them.

• Care planning and service coordination
• Develop individualized, person-centered care plans that support successful community living.
• Coordinate services and supports with healthcare providers, community agencies, family members, and interdisciplinary team members.
• Monitor service delivery and make recommendations to ensure participant needs are met.
• Collaborate with housing coordinators, transition coordinators, facility staff, and state partners throughout the transition process.

• Transition planning
• Participate in discharge planning and transition meetings.
• Coordinate community-based services, supports, and authorizations necessary for discharge.
• Ensure emergency backup plans and required documentation are completed prior to transition.
• Support participants and families through all phases of the transition process.

• Ongoing case management and quality monitoring
• Provide post-transition follow-up and quality management services.
• Maintain regular contact with participants according to program requirements.
• Monitor participant stability, address concerns, and facilitate access to additional resources as needed.
• Complete incident reporting and documentation in accordance with program standards.

• Team collaboration
• Participate in team meetings, trainings, and statewide initiatives.
• Work collaboratively with agency staff, state partners, healthcare providers, and community organizations.
• Demonstrate flexibility and a commitment to supporting both consumers and team objectives.

Qualifications

• Required qualifications
• Bachelor's degree in Social Work, Human Services, Nursing, Psychology, Gerontology, Public Health, or a related field.
• Minimum of two years of experience in case management, care management, social services, discharge planning, healthcare, or long-term services and supports.
• Strong assessment, documentation, organizational, and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to work independently and collaboratively within a multidisciplinary team.
• Valid driver's license and reliable transportation for community visits.

Preferred Qualifications

• Experience working with older adults and individuals with disabilities.
• Knowledge of Medicaid, waiver programs, and long-term services and supports.
• Familiarity with person-centered planning and community-based service coordination.
• Experience in care transitions, discharge planning, or community case management.

Join our team

At AOASCC, you'll have the opportunity to build a rewarding career while helping individuals regain independence and successfully return to their communities. If you're looking for meaningful work, a supportive team, and a schedule that promotes work-life balance, we'd love to hear from you.

Apply today and help make community living possible for those who need it most.