Community Based Care Manager

Collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of individuals, natural supports, and the population through culturally competent delivery of care and coordination of services and supports.

Responsibilities

• Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivational interviewing to complete health and psychosocial assessments through a health equity lens unique to each member’s needs, identifying cultural, linguistic, social, and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks.
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member.
• Engage with the member in a variety of settings (e.g., hospital, provider office, community agency, member’s home, telephonic, or electronic communication) to establish an effective, professional relationship.
• Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on the member’s desires, needs, and preferences.
• Identify and manage barriers to achievement of care plan goals.
• Identify and implement effective interventions based on clinical standards and best practices.
• Empower the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management.
• Facilitate coordination, communication, and collaboration with the member and ICT to achieve goals and maximize positive member outcomes.
• Educate the member and natural supports about treatment options, community resources, insurance benefits, etc., to enable timely and informed decisions.
• Employ ongoing assessment and documentation to evaluate the member’s response to and progress on the ICP.
• Evaluate member satisfaction through open communication and monitoring of concerns or issues.
• Monitor and promote effective utilization of healthcare resources through clinical variance and benefits management.
• Verify eligibility, previous enrollment history, demographics, and current health status of each member.
• Complete psychosocial and behavioral assessments by gathering information from the member, family, provider, and other stakeholders.
• Oversee timely psychosocial and behavioral assessments, care planning, and execution of meeting member needs.
• Participate in meetings with providers to inform them of Care Management services and benefits available to members.
• Assist with ICDS model of care orientation and training for facility and community providers.
• Identify and address gaps in care and access.
• Collaborate with facility-based healthcare professionals and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner.
• Coordinate with community-based organizations, state agencies, and other service providers to ensure coordination and avoid duplication of services.
• Adjust the intensity of programmatic interventions based on established guidelines, member preferences, changes in healthcare needs, and care plan progress.
• Appropriately terminate care coordination services based on established case closure guidelines for members not enrolled in contractually required ongoing care coordination.
• Provide clinical oversight and direction to unlicensed team members as appropriate.
• Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies.
• Continuously assess for areas to improve processes to enhance the member experience and share insights with leadership.
• Travel regularly to conduct member, provider, and community-based visits as needed.
• Adhere to NCQA and CMSA standards.
• Perform any other job duties as requested.

Requirements

• Nursing degree from an accredited nursing program or Bachelor’s degree in a healthcare field, or equivalent years of relevant work experience.
• Licensure as a Registered Nurse, Professional Clinical Counselor, or Social Worker.
• Advanced degree associated with clinical licensure preferred.
• Minimum of three (3) years of experience in nursing, social work, counseling, or a healthcare profession (e.g., discharge planning, case management, care coordination, and/or home/community health management).
• Three (3) years of Medicaid and/or Medicare managed care experience preferred.
• Current unrestricted clinical license in the state of practice as a Registered Nurse, Social Worker, or Clinical Counselor. Licensure may be required in multiple states as applicable.
• Case Management Certification highly preferred.
• Valid driver’s license, vehicle, and verifiable insurance. Employment conditional on successful clearance of a driver’s license record check and verified insurance.
• Annual Influenza vaccination required for designated positions during Influenza season (October 1 – March 31).

Skills

• Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation, and adherence.
• Intermediate proficiency with Microsoft Office (Outlook, Word, Excel).
• Ability to communicate effectively with a diverse group of individuals.
• Ability to multi-task and work independently within a team environment.
• Knowledge of local, state, and federal healthcare laws and regulations, and company policies regarding case management practices.
• Adherence to a code of ethics aligned with professional practice.
• Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice.
• Strong advocacy for members at all levels of care.
• Strong understanding and sensitivity to all cultures and demographic diversity.
• Ability to interpret and implement current research findings.
• Awareness of community and state support resources.
• Critical listening and thinking skills.
• Strong decision-making and problem-solving skills.
• Strong organizational and time management skills.

Pay

$56,430.00 - $90,360.00 annually. Salary is determined by a combination of education, training, experience, scope and complexity of the role, discretion required, and external/internal data. Bonus eligibility tied to company and individual performance may apply.

Benefits

CareSource offers a substantial and comprehensive total rewards package.

Schedule

• This is a mobile position requiring regular travel to different work locations, including homes, offices, or other public settings.
• Must reside in the same territory assigned to work in; exceptions may be considered based on business need.
• May be required to travel greater than 50% of the time.
• Flexible hours, including possible evenings and/or weekends as needed to serve members.
• Exposure to weather conditions typical of the location; may require standing or sitting for long periods.
• Use of general office equipment (e.g., telephone, photocopier, fax machine, personal computer).