Careers / Job Openings & Descriptions
Benefit Plan / Living in Northwest Wisconsin

A Care Manager's day is...

At NorthernBridges we’re often asked, “What is a typical day?” The short response is that there is no typical day! Each of our days is dependent on our members and what is happening in their lives that requires the support and assistance from their care management team.

Perhaps easier to describe is the care management team. Care management is similar to case management, which is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health and safety needs and personal goals. At NorthernBridges, these individuals are our members.

Members are referred to NorthernBridges and the Family Care program by first meeting with their local Aging and Disability Resource Center (ADRC). Members have to be financially eligible for Medicaid and functionally eligible for Family Care. Members are functionally eligible for Family Care if they are found to be physically disabled, developmentally disabled or a frail elder. Each NorthernBridges’ member is assigned an inter-disciplinary team (IDT) that consists of a Social Services Care Manager (SSCM) and a Nurse Care Manager (RNCM).

Day-to-Day Activities

In general, day-to-day activities for care managers include:

• Member visits for assessments or to address member concerns.

• Entering case notes and assessments into our computer charting system.

• IDT consult to address day-to-day member concerns and phone calls.

• Follow-up phone calls and visits to ensure members are following IDT recommendations and are satisfied with services.

• Meetings with internal partners such as the Behavioral Health Specialist or Member Rights Specialist and external partners such as care providers.

• Participate in NorthernBridges’ work groups and committees.

Care managers have a number of specific responsibilities in the development of supports to meet a member’s health and safety needs and personal outcomes. Primary responsibilities are:

• At a minimum, complete a member assessment two times a year.

• From the assessment, the IDT collaborates to develop a Member Centered Plan (MCP) to meet member-defined goals. These are known as the member’s outcomes.

• Within the MCP process, it is the IDT’s responsibility to identify risk and address this with the member.

• Through assessment of the member’s health and safety needs along with their outcomes, the IDT authorizes the appropriate services and/or helps the member find informal and/or community supports. Informal supports are usually family or friends.

• The authorization of services starts with the IDT utilizing the Resource Allocation Decision (RAD) method. This is a conversation with the IDT, the member and family/guardian, if appropriate, to find the most effective way to meet the member’s outcomes.

In addition to collaborating as part of an IDT, team members have responsibilities to support the member and IDT.

Each SSCM has 35-40 members on their case load and have the following primary responsibilities:

• implementing plans to support member’s desired living arrangements, daily routine, meaningful activities and relationships, community involvement, and mental health

• management of the formal and informal supports for these areas requires frequent contact with the member, service providers, and informal supports

• take the lead in resolving situations that arise with member’s finances, eligibility for programs, legal issues, and unforeseen life circumstances that they may not be able to resolve independently

• consultation with the RNCM on medical issues

Each RNCM has approximately 75-80 members on their caseload and have the following primary responsibilities:

• educate and advocate for the member to promote healthy living

• flu and pneumonia vaccination education and promotion

• maintain the health records to include medication list, diagnosis list, immunizations, preventative procedures, and allergies

Together, the RNCM and SSCM work with discharging facilities on discharge planning. The IDT assists the member to stay eligible for Medicaid and Family Care benefits. This process involves updating the Long-Term Care Functional Screen yearly and assisting members with their yearly Medicaid Recertification.