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 individuals, 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 address behavioral, physical, and social determinants of health needs.

Responsibilities

• Engage members and their natural support systems 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 member needs.
• Engage with members in various settings (e.g., hospital, provider office, community agency, member’s home, telephonic, or electronic communication) to establish effective professional relationships.
• 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 achieving care plan goals.
• Identify and implement effective interventions based on clinical standards and best practices.
• Empower members 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 outcomes.
• Educate members and natural supports about treatment options, community resources, and insurance benefits to enable informed decisions.
• Employ ongoing assessment and documentation to evaluate member 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 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 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 to plan for post-discharge care or facilitate transitions to appropriate levels 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 or changes in healthcare needs.
• 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 responses in a timely manner according to standards of practice and CareSource policies.
• Continuously assess and improve processes to enhance the member experience with CareSource.
• Travel regularly to conduct member, provider, and community-based visits as needed.
• Adhere to NCQA and CMSA standards.
• Perform other job duties as requested.

Requirements

• Nursing degree from an accredited nursing program or a Bachelor’s degree is required.
• Licensure as a Registered Nurse is required.
• Advanced degree associated with clinical licensure is 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 is preferred.
• Current unrestricted clinical license in the state of practice as a Registered Nurse, Social Worker, or Clinical Counselor is required. Licensure may be required in multiple states as applicable.
• 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 based on 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 and may require standing or sitting for long periods.
• 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, to serve the needs of members.

Pay

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

Benefits

CareSource offers a substantial and comprehensive total rewards package, including base compensation and potential bonuses tied to performance.