[Hiring] Care Manager RN Mom and Baby @CareSource

Role Description

The 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 with culturally competent delivery of care, services and supports. Facilitates communication, coordinates care and service of the member through assessments, identification, person-centered planning, assist 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.

• Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing.
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member.
• Engage with the member to establish an effective, professional relationship via telephonic or electronic communication.
• Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT.
• Identify and manage barriers to achievement of care plan goals.
• Identify and implement effective interventions based on clinical standards and best practices.
• Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care.
• Facilitate coordination, communication and collaboration with the member and the ICT.
• Educate the member/natural supports about treatment options, community resources, insurance benefits, etc.
• 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.
• Coordinate with community-based organizations, state agencies, and other service providers.
• Adjust the intensity of programmatic interventions based on established guidelines.
• Appropriately terminate care coordination services based upon 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.
• Continuously assess for areas to improve the process to enhance the members’ experience.
• Adhere to NCQA and CMSA standards.
• Perform any other job duties as requested.

Qualifications

• Nursing degree from an accredited nursing program is required.
• Advanced degree associated with clinical licensure is preferred.
• A minimum of three (3) years of experience in nursing is required.
• Three (3) years Medicaid and/or Medicare managed care experience is preferred.
• Three (3) years prior maternity or NICU experience preferred.

Requirements

• Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence.
• Intermediate proficiency level 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 & federal healthcare laws and regulations & all company policies regarding case management practices.
• Adhere to 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 advocate for members at all levels of care.
• Strong understanding and sensitivity of all cultures and demographic diversity.
• Ability to interpret and implement current research findings.
• Awareness of community & state support resources.
• Critical listening and thinking skills.
• Decision making and problem-solving skills.
• Strong organizational and time management skills.

Licensure and Certification

• Current unrestricted clinical license in state of practice as a Registered Nurse is required.
• Licensure may be required in multiple states as applicable based on State requirement of the work assigned.
• Case Management Certification is highly preferred.

Working Conditions

• 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.

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, 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. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type

Salary

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. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.