Community Based Care Manager - Clark County - R9650-2

About the Role

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. This role facilitates communication, coordinates care, and assists members in creating and evaluating person-centered care plans to prioritize and address behavioral, physical, and social determinants of health needs with the aim to improve lives.

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.
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member.
• Engage with the member in various 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, and insurance benefits 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 and the 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.
• 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 and member preferences, changes in healthcare needs, and care plan progress.
• Appropriately terminate care coordination services based on established case closure guidelines.
• 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 processes to improve the member experience and share findings 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 is required.
• Advanced degree associated with clinical licensure is preferred.
• A 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 is preferred.
• Current unrestricted clinical license in the state of practice as a Registered Nurse, Social Worker, or Clinical Counselor.
• Case Management Certification is highly preferred.
• Must have a valid driver’s license, vehicle, and verifiable insurance.
• Influenza vaccination is required annually (October 1 – March 31) as a condition of continued employment.
• Must reside in the same territory assigned to work in; exceptions may be considered due to business need.

Skills

• Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation, and adherence.
• Intermediate proficiency 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, 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 cultural 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.

Working Conditions

• This is a mobile position requiring regular travel to different work locations, including homes, offices, or other public settings.
• Exposure to weather conditions typical of the location.
• May be required to stand and/or sit for long periods of time.
• May be required to travel greater than 50% of the time to perform work duties.
• 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 members.

Pay

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, discretion, and latitude required for the role when establishing salary. In addition to base compensation, you may qualify for a bonus tied to company and individual performance.

Benefits

CareSource offers a substantial and comprehensive total rewards package.