[Hiring] Care Guide @CareSource

Role Description

The Care Guides are responsible for participating as a member of the inter-disciplinary Care Coordination Team to coordinate care for members, meeting their individual needs and the needs of the population. The Care Guide serves as a single point of contact for care coordination when there is no CCE or OhioRISE Plan and/or CME involvement & short-term care coordination needs are identified. The Care Guide Plus serves as a single point of contact for care coordination when there is a CCE, OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. Members needing Care Guide or Care Guide Plus assistance for longer than 60 calendar days should be considered for referral to a Care Manager.

• Engage with the member in a variety of settings to establish an effective, professional relationship.
• Participate in the identification of the individual’s needs and prioritize efforts in collaboration with the member and caregivers.
• Gather information to identify and manage barriers to care.
• Take appropriate steps to close gaps in care where appropriate.
• Under the supervision of the Care Manager, implement effective interventions based on clinical standards and best practices.
• Maximize the client’s health, wellness, safety, adaptation, and self-care through effective care coordination.
• Educate the member and other stakeholders about treatment options, community resources, insurance benefits, etc.
• Gather information to assist the Care Manager to evaluate the member’s response to the plan of care as requested.
• Evaluate client satisfaction through open communication and monitoring of concerns or issues.
• Assist members in filing of Grievances & Appeals as appropriate.
• Collaborate with Care Managers and providers to plan for post-discharge care needs.
• Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies.
• Start each interaction with members wondering, “What does the world look like for this person, and how can I meet him or her where they are?”
• Look for ways to improve the process to make the members experience with CareSource easier.
• Regular travel to conduct member visits, provider visits, and community-based visits as needed.
• Perform any other job duties as requested.

Qualifications

• Associate’s Degree or equivalent years of relevant work experience is required.
• Active, unrestricted allied health certification or LPN license may be considered in lieu of Associate’s Degree.
• Minimum of one (1) year of clinical experience in nursing, social services, or healthcare field is required.
• Medicaid and/or Medicare managed care experience is preferred.

Requirements

• Proficient with Microsoft Office, including Outlook, Word, and Excel.
• Sensitivity to and experience working within different cultures.
• Good interpersonal skills.
• Ability to work independently and within a team environment.
• Ability to identify problems and opportunities and communicate to management.
• Developing knowledge of local, state & federal healthcare laws and regulations.
• Demonstrate compassion, support, and collaboration with members and families.
• Self-motivated and inquisitive.
• Comfort with asking pertinent questions.
• Ability to work in a fast-paced environment.
• Ability to demonstrate and promote ethical conduct.
• Ability to develop positive relationships with all stakeholders.
• Awareness of community & state support resources.
• Organized, detail-oriented, and conflict resolution skills.
• Ability to keep composure and professionalism during times of high emotional stress.
• Ability to maintain confidentiality and act in the company’s best interest.
• Proven track record of demonstrating empathy and compassion for individuals.
• Proven track record for improving processes to make things easier for those you have served.

Licensure and Certification

• Clinical or Care Management Certification is preferred.
• Employment in this position is conditional pending successful clearance of a driver’s license record check.
• Employment in this position is conditional pending successful clearance of a criminal background check.
• Influenza vaccination is a requirement of this position.

Working Conditions

• This is a mobile position, meaning that regular travel to different work locations is essential.
• Will be exposed to weather conditions typical of the location.
• May be required to stand and/or sit for long periods of time.
• Reside in the same territory they are assigned to work in; exceptions may be considered.
• May be required to travel greater than 50% of time to perform work duties.
• Flexible hours, including possible evenings and/or weekends as needed.

Compensation Range

$47,400.00 - $76,000.00

• CareSource takes into consideration a combination of a candidate’s education, training, and experience.
• You may qualify for a bonus tied to company and individual performance.
• We offer a substantial and comprehensive total rewards package.

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

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.