+ GENERAL SUMMARY + The Fortify Licensed Care Manager has the opportunity to leverage clinical expertise in caring for Virginia’s most vulnerable children and their families. The Licensed Care Manager utilizes their skills and knowledge base to support the optimal health and wellness of the pediatric patient. Through telephonic outreach, the Licensed Care Manager will communicate with patients’ families to complete assessments and develop individualized care plans that best support the medical and social needs of the patient and family. Highly developed written and verbal communication skills that facilitate patient/family understanding of health needs is essential. The Licensed Care Manager provides education, support, referrals, advocacy, and ongoing care coordination to support patient and family wellness. The position requires strong organizational skills in order to multi-task and prioritize referrals, assignments, and requests. The successful candidate has a demonstrated track record of building respectful rapport and trust with patients, families, providers and community partners, completing assessments of physical and psychosocial needs, identifying appropriate healthcare and community resources, and collaborating with team members. This position requires confidentiality, discretion, and compassion. + ESSENTIAL DUTIES AND RESPONSIBILITIES + Provides care that is inclusive and respectful of socioeconomic status, race, ethnicity, age, mental or physical disability, religion, gender, sexual orientation, or national origin. + Builds open, trusting, respectful relationships with diverse patients and families both remotely and in person. + Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social factors which impact optimal health. + Anticipates and responds to patient and family needs. + Problem-solves unique barriers to communication and care. + Communicates effectively with diverse audiences both orally and in writing. + Works with interdisciplinary teams to improve patient, family, and community outcomes. + Electronically documents care according to industry and institutional standards. + Performs other duties as assigned. + The job includes the following essential functions: + Program development and refinement in support of the Fortify Children’s Health mission and Fortify Cares priorities. + Comprehensive and continuous assessment of patient and family including medical, social, educational and personal history. + Identification of and access to community resources to optimize effective and efficient care outcomes in collaboration with the multidisciplinary team. + Advocating for patients and family members in conjunction with the healthcare team and Fortify team members. + Patient-centered care planning that results in development, implementation, and ongoing evaluation of an individualized plan of care that is agreed-upon by the patient and family and communicated between care providers while ensuring patients and family members are actively informed of and participating in the care process in conjunction with the care team members. + Ability to document and communicate in compliance with HIPAA and other regulatory guidelines. + Education and support for patients and caregivers. + Ongoing Identification and Referral to appropriate community resources based on assessment of needs. + Consistent documentation that meets care, regulatory and accreditation requirements. + LICENSES AND/OR CERTIFICATIONS + Registered Nurse with current, unrestricted Virginia license or Licensed Clinical Social Worker. + CCM Preferred. + MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS + Graduate of an accredited Registered Nursing program. BSN preferred. + 2+ years of relevant professional Care Management experience. + Strong understanding of Care Coordination best practices. + Proficient computer skills. + Strong organizational skills and the ability to work independently. + Excellent communication skills and the ability to interact with diverse individuals. + Bilingual (English/Spanish) preferred. + Preferential consideration given for experience working with children, families, community partners or in a behavioral health setting. + Prior work with Medicaid population a plus. + Experience conducting medication reconciliation with patients and identifying discrepancies. + Experience communicating with medical providers regarding patient needs. + Comfort working in a fast pace and dynamic “startup” environment. + WORKING CONDITIONS + Normal office environment with little exposure to excessive noise, dust, temperature and the like. + PHYSICAL REQUIREMENTS + Click here to view physical requirements. (https://www.chkd.org/uploadedFiles/Documents/Employees/Category%20B%20Jobs.pdf)