Job Description
Title: Community Based Care Manager
Contract: 12 month contract
Location: Travel Onsite in Cleveland Area
Schedule: 8-5 EST
Start Date: ASAP
Essential Functions:
- 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 unique to the needs of each member that identify the 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 to establish an effective, professional relationship. Settings for engagement include but are not limited to hospital, provider office, community agency, member’s home, telephonic or electronic communication
- Develop a person-centered individualized care plan (ICP) in collaboration with the ICT, based on 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
- Assist with empowering 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 the ICT in order to achieve goals and maximize positive member outcomes
- Educate the member/ natural supports about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made
- 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
- Monitors and promotes effective utilization of healthcare resources through clinical variance and benefits management
- Verify eligibility, previous enrollment history, demographics and current health status of each member
- Completes psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholders
- Oversee (point of contact) 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
- Assists 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 case managers 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 case managers and other service providers to ensure coordination and avoid duplication of services
- Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required on going 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 make the members experience with CareSource easier and shares with leadership to make it a standard, repeatable process
- Regular travel to conduct member, provider and community-based visits as needed to ensure effective administration of the program
- Adherence to NCQA standards (CMSA standards below)
- Perform any other job duties as requested
Education and Experience:
- Nursing degree from an accredited nursing program or Bachelor’s degree in a health care field or equivalent years of relevant work experience is required
- Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is required
- Advanced degree associated with clinical licensure is preferred
- A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required
- Three (3) years Medicaid and/or Medicare managed care experience is preferred