Community Based Care Manager RN

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. 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.

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 the 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 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 of both 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 and in accordance with the member’s preferences, changes in special 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 regarding professional documentation.
• Continuously assess for areas to improve the process to enhance the member’s experience with CareSource and share insights with leadership to standardize improvements.
• Travel regularly to conduct member, provider, and community-based visits as needed to ensure effective administration of the program.
• Adhere to NCQA and CMSA standards.
• Perform any other job duties as requested.

Requirements

• Nursing degree from an accredited nursing program is required.
• Licensure as a Registered Nurse is required.
• Advanced degree associated with clinical licensure is preferred.
• A minimum of three (3) years of experience in nursing.
• 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.
• Case Management Certification is highly preferred.
• Must have a valid driver’s license, vehicle, and verifiable insurance. Employment is conditional pending successful clearance of a driver’s license record check and verified insurance.
• Influenza vaccination is required annually (October 1 – March 31) as a condition of continued employment.

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 all company policies regarding case management practices.
• Adherence to a 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 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.
• 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.
• Must reside in the same territory assigned to work in; exceptions may be considered due to business need.
• 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 our members.

Pay

$62,700.00 - $100,400.00 annually. 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.

Benefits

CareSource offers a substantial and comprehensive total rewards package.