[Hiring] Community Based Care Manager RN @CareSource

Role Description

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.

Qualifications

• 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 Medicaid and/or Medicare managed care experience is preferred

Requirements

• Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens.
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings.
• Engage with the member in various settings to establish an effective, professional relationship.
• 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.
• 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 member experience.
• Regular travel to conduct member, provider and community-based visits as needed.
• Adhere to NCQA and CMSA standards.
• Perform any other job duties as requested.

Benefits

• Compensation Range: $62,700.00 - $100,400.00
• In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
• Comprehensive total rewards package.

Working Conditions

• This is a mobile position, requiring regular travel to different work locations.
• Exposure to weather conditions typical of the location.
• Must reside in the same territory they are assigned to work in.
• May be required to travel greater than 50% of time to perform work duties.
• Flexible hours, including possible evenings and/or weekends as needed.

Licensure and Certification

• Current unrestricted clinical license in state of practice as a Registered Nurse.
• Case Management Certification is highly preferred.
• Must have valid driver’s license, vehicle and verifiable insurance.
• Influenza vaccination is a requirement of this position.

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.