Geriatric Care Manager SCO Tufts

Job Description

Job Description

Job description

The mission of Central Boston Elder Services is to provide high-quality, responsive, supportive services and programs to the elderly and the disabled in need of health and human services. Central Boston Elder Services seeks in its philosophy to provide services in a manner that reinforces the dignity and worth of the individuals and also acknowledges and respects cultural sensitivity, gender, and other differences while serving the community with vision and integrity.

We are committed to partnering with families, caregivers, and community entities that embrace the philosophy and our mission to reduce social, economic, and health disparities.

POSITION SUMMARY:

The Geriatric Support Services Coordinator (GSSC) is the care manager assigned to work with SCO enrollees and is a member of the Primary Care Team (PCT). The GSSC is responsible for coordinating and providing community social services to SCO enrollees by the SCO’s policies, procedures, and practices.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• As a member of the Primary Care team (PCT), participate in Initial and Ongoing Assessments of the health and functional status of enrollees and develop community-based care plans and related service packages necessary to improve or maintain an enrollee’s health and functioning.
• Arrange, coordinate, and authorize the provision of appropriate long-term care and social support services for enrollees (with the agreement of the PCT and by requirements set forth by the SCO). These may include but not be limited to: ADL and IADL assistance; Housing Resources; Home-delivered Meals; Transportation; and Mass Health Eligibility Assistance.
• Monitor the appropriate provision and functional outcomes of community long-term care services that have been authorized by the PCT.
• Track enrollee transfers and adjust service plans as deemed appropriate by the PCT and by requirements set forth by the SCO.
• Provide care management services via the telephone as requested by SCO RN.
• Prepare documentation for enrollee files, Agency database, and SCO plan database.
• Perform all services by state and federal law and written SCO management protocols, including timely entry of all information required to be included in the Centralized Enrollee Record (CER).
• Maintain care management documentation as specified in SCO care management protocols.
• Report suspected Fraud, Waste and Abuse (FW&A) as required by CBES FW&A policy.
• Protect Consumers’ Personal Health Information (PHI) and report any suspected security breaches promptly.
• Respond promptly to enrollee service requests.
• Attend and participate in PCT, Agency, and departmental meetings and trainings as required.
• Other duties as assigned.

QUALIFICATIONS:

• Bachelor’s Degree and two years of professional experience in case management, service coordination, outreach, and/or advocacy with persons over the age of 65 preferred.
• Ability to assess clients and their needs and knowledge of the community-based service network.
• Excellent interpersonal and problem-solving skills required.
• Ability to work with a diverse population and within a multi-disciplinary team.
• Access to car required.
• Knowledge of: Cantonese and Mandarin preferred.
• Ability to walk stairs.
• Ability to carry a laptop and documents required to complete a home visit.

PHYSICAL REQUIREMENTS OF THE JOB:

• Ability to lift and carry objects frequently weighing up to 10 to 15 pounds.
• Ability to climb stairs.
• Ability to travel to the community to perform visits at consumers’ homes.
• Work requires regularly standing, stooping, and bending.