Community Based Care Manager - Clark County - R9650-1

Job Summary

The 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 the individual, natural supports and the population through culturally competent delivery of care and coordination of services and supports.

Facilitates communication, coordinates care and service of the member through assessments, identification and planning, and assists the member in creation and evaluation of person-centered care plans to prioritize and address what matters most, behavioral, physical and social determinants of health needs with the aim to improve the lives of our members.

Essential Functions

• Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the 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 to establish an effective, professional relationship. Settings for engagement include but are not limited to hospital, provider office, community agency, member’s home, telephonic or electronic communication
• Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on 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
• Assist with empowering 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 the ICT in order to achieve goals and maximize positive member outcomes
• Educate the member/ natural supports about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made
• Evaluate 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
• Maintain effective utilization of healthcare resources through clinical variance and benefits management
• Monitor and promote effective utilization of healthcare resources through clinical variance and benefits management
• 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 provided to member based on established guidelines and in accordance with the member’s preferences, changes in special healthcare needs, and care plan progress
• Properly terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required ongoing care coordination
• Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation
• Continuously assess for areas to improve the process to make the members experience with CareSource easier and shares with leadership to make it a standard, repeatable process
• Regular travel to conduct member, provider and community-based visits as needed to ensure effective administration of the program
• Adhere to NCQA and CMSA standards

Education And Experience

• Nursing degree from an accredited nursing program or Bachelor’s degree in a health care field or equivalent years of relevant work experience is required
• Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is required
• Advanced degree associated with clinical licensure is preferred
• A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required
• Three (3) years Medicaid and/or Medicare managed care experience is preferred

Competencies, Knowledge And Skills

• Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence
• Intermediate proficiency level with Microsoft Office, including Outlook, Word and 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 & federal healthcare laws and regulations & all company policies regarding case management practices
• Adhere to code of ethics that aligns with professional practice
• Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice
• Strong advocate for members at all levels of care
• Strong understanding and sensitivity of all cultures and demographic diversity
• Awareness of community & state support resources
• Critical listening and thinking skills
• Decision making and problem-solving skills
• Strong organizational and time management skills

Licenses And Certifications

• Current unrestricted clinical license in state of practice as a Registered Nurse, Social Worker or Clinical Counselor is required. Licensure may be required in multiple states as applicable based on State requirement of the work assigned
• Case Management Certification is highly preferred

Employment Conditions

• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members

Compensation

Compensation Range: $62,700.00 - $100,400.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.

CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.