Care Guide

CareSource•Mobile, AL

6d•$46,500 - $74,500

About The Position

The Care Guide Plus – Community Based role is 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 and 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. Essential Functions: 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 Participate in the identification of the individual’s needs and prioritizes 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. so that timely and informed decisions can be made 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 or facilitate transition to an appropriate level of care in a timely and cost-effective manner Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation Starts 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? What are his or her unique needs, and how can CareSource help?” In each interaction, the employee will aspire to help the member to feel informed, empowered, and supported by CareSource Looks for ways to improve the process to make the members experience with CareSource easier and shares with leadership to make it a standard, repeatable process Document all transitions of care, including sentinel events, in the MCO and OhioRISE Care Coordination Portals (CCP) Once documented, will send electronic notifications of sentinel events to the member’s authorized users in the MCO or OhioRISE Care Coordination portals Serve as Central Point of Contact for OhioRISE, CCE, and CME entities The Care Guide Plus will collaborate with OhioRISE, CCE, and CME entities to obtain and share any Release of Information (ROI) information and documentation in order to maintain HIPPA and other privacy requirements Trained to administer the CANS assessment Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program Perform any other job duties as requested

Requirements

Associate’s Degree or equivalent years of relevant work experience is required
Minimum of one (1) year of clinical experience in nursing, social services, or healthcare field (discharge planning, case management, care coordination, and/or home/community health experience) is required
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 and all company policies regarding case management practices
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 and 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
Must have valid driver’s license, vehicle and verifiable insurance.
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.
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position.
CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment.

Nice To Haves

Medicaid and/or Medicare managed care experience is preferred
Clinical or Care Management Certification is preferred

Responsibilities

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 prioritizes 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. so that timely and informed decisions can be made
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 or facilitate transition to an appropriate level of care in a timely and cost-effective manner
Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation
Starts 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? What are his or her unique needs, and how can CareSource help?”
Looks for ways to improve the process to make the members experience with CareSource easier and shares with leadership to make it a standard, repeatable process
Document all transitions of care, including sentinel events, in the MCO and OhioRISE Care Coordination Portals (CCP)
Serve as Central Point of Contact for OhioRISE, CCE, and CME entities
The Care Guide Plus will collaborate with OhioRISE, CCE, and CME entities to obtain and share any Release of Information (ROI) information and documentation in order to maintain HIPPA and other privacy requirements
Trained to administer the CANS assessment
Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program
Perform any other job duties as requested