Basic Function:        To manage a CHOICES caseload. To educate and promote awareness of community services. To train and orient new staff, assist with new program initiatives, and pilot work groups.

 Responsibilities:

•  Coordinate and assist with training new staff for the Care Manager position, including but not limited to teaching AGE documentation requirements, program standards and shadowing of home visits.
• Test new program initiatives set forth by AGE and/or Tri Valley, Inc. that directly impact the SHC department.
• Participate in pilot work groups set forth by AGE and/or Tri Valley, Inc. that directly impact the SHC department. 
• Assist the SHC Director and SHC Supervisor with reviews of SHC business practices and provider billing.
• Review and approve submitted closings and annual reassessments ensuring that changes are updated in the consumer file. Submit QA sheets to Care managers and supervisor team for corrections
• Coordinate consumer services when transitioning into the community from a nursing home setting.
• Collaborate with CAE department and RN Manager on Choices care plans and extended care plans.
• Develop service plan and supportive networks through contact with consumer, formal and informal supports, and consultation with supervisor.
• Conduct assessments with consumers including social, emotional, physical, and environmental status to determine needs. 
• Work with Community Transition Liaison to coordinate consumer services, discharge process and purchasing goods and services when transitioning into the community from a nursing home setting.
• Assist and provide support to families and consumers.  Encourage self-advocacy. 
• Coordinate a Choices level of services for consumers in the community which could entail 42+ hours up to 24x7. 
• Have a high level of organization managing a caseload. 
• Keep journal notes up to date, including changes/issues in services, including summary of telephone contacts, service changes, calls concerning consumers and keep files up to date.
• Have knowledge of MassHealth and Waiver guidelines
• Be able to work with multiple vendors/ coordinators to ensure authorized services are placed and resumed/suspended as needed in a timely manner. 
• Implement service plans by phone or email immediately followed by authorization to provider agencies.
• Be able to organize in addition to quarterly visits, every other month visits for consumers who have care plans over 42 hours. 
• Accurately manage reports and submit them by designated deadlines.
• Assist consumers to obtain and utilize other community services such as: VNA, housing, fuel assistance, COA, etc.
• Regularly communicate with supervisor and meet on a regular basis.
• Participate in quarterly Extended Care plan meetings.