Community Based Care Manager - Reno and surrounding areas

CareSource is seeking a Community Based Care Manager to collaborate with an inter-disciplinary care team (ICT), providers, and community organizations to deliver culturally competent care and coordinate services for members. This role focuses on improving quality of life through person-centered care plans that address behavioral, physical, and social determinants of health.

Responsibilities

• Engage members and their natural support systems through strength-based assessments and trauma-informed care, using motivational interviewing to complete health and psychosocial assessments with a health equity lens.
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to address member needs.
• Develop and maintain professional relationships with members in various settings, including hospitals, provider offices, community agencies, members’ homes, or via telephonic/electronic communication.
• Create and update person-centered individualized care plans (ICP) in collaboration with the ICT, based on member desires, needs, and preferences.
• Identify and manage barriers to care plan goals and implement effective interventions based on clinical standards and best practices.
• Empower members to manage and improve their health, wellness, safety, and self-care through care coordination and case management.
• Coordinate communication and collaboration among members, the ICT, and other stakeholders to achieve goals and maximize positive outcomes.
• Educate members and natural supports about treatment options, community resources, and insurance benefits to facilitate informed decision-making.
• Conduct ongoing assessments and document member progress and response to the ICP.
• Evaluate member satisfaction through open communication and monitoring of concerns or issues.
• Promote effective utilization of healthcare resources through clinical variance and benefits management.
• Verify member eligibility, enrollment history, demographics, and current health status.
• Complete psychosocial and behavioral assessments by gathering information from members, families, providers, and other stakeholders.
• Oversee timely psychosocial and behavioral assessments, care planning, and execution of member needs.
• Participate in provider meetings 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 to services.
• Collaborate with facility-based healthcare professionals to plan post-discharge care or facilitate transitions to appropriate levels of care.
• Coordinate with community-based organizations, state agencies, and other service providers to avoid duplication of services.
• Adjust the intensity of programmatic interventions based on established guidelines, member preferences, and care plan progress.
• Terminate care coordination services according to established case closure guidelines for members not enrolled in ongoing care coordination.
• Provide clinical oversight and direction to unlicensed team members as appropriate.
• Document care coordination activities and member responses in a timely manner according to CareSource policies.
• Continuously assess and 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.

Requirements

• Nursing degree from an accredited 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, 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 (may require licensure in multiple states).
• 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.
• Annual Influenza vaccination required during flu season (October 1 – March 31) as a condition of employment.

Skills

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

Schedule

• Mobile position requiring regular travel to various work locations, including homes, offices, or other public settings.
• Must reside in the assigned territory; exceptions may be considered based on business need.
• May require travel greater than 50% of the time.
• Flexible hours, including possible evenings and/or weekends to meet member needs.
• Use of general office equipment (telephone, photocopier, fax machine, personal computer).

Pay

$62,700.00 - $100,400.00 annually. Salary is determined by a combination of education, training, experience, scope and complexity of the role, and external/internal data. Bonus opportunities may be available based on company and individual performance.

Benefits

CareSource offers a substantial and comprehensive total rewards package, including well-being programs and professional development opportunities.