Community Based Care Coordinator - Nevada

CareSource Management Services•Ely, NV

About The Position

The Community Based Care Coordinator - Nevada assists enrollees in navigating their health care providing care planning and coordination of services, ensuring timely service delivery and prompting continuity of care through coordinated outreach and engagement with members and providers. The role collaborates with members of an inter-disciplinary care team (ICT) to meet the needs of the individual and the population and identifies problems or opportunities that would benefit from care coordination. This role is responsible for routine enrollee outreach, including community-based visits, telephonic or virtual visits, documenting service activities, and supporting administrative functions that enhance member satisfaction.

Requirements

Associates of Science (A.S) in a healthcare related field required
Three (3) years of experience in a healthcare field (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) required
Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
Customer service focus with exceptional listening, written and verbal communication skills
Displays professional phone etiquette
Ability to multitask using a variety of computer applications
Strong organizational skills and time management skills
Effective problem solving skills with attention to detail
Ability to work independently and within a team environment
Understanding and supportive of managed care concept
Adaptable to a constantly changing environment
Able to type (document) and talk (telephonically) simultaneously
Developing knowledge of local, state and federal healthcare laws and regulations and all company policies regarding case management practices
Strong understanding and respect of all cultures and demographic diversity
Awareness of community & state support resources
Strong advocate for members at all levels of care
Strong analytical, problem solving, and critical thinking skills, with attention to detail
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.
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.
Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations.

Nice To Haves

Bachelor of Science (B.S) in a healthcare related field preferred
Knowledge of Medicaid, Medicare and Managed Care is preferred
Behavioral or mental health certification or equivalent approved training program preferred

Responsibilities

Assists enrollees with understanding health plan processes, appeals and grievances and assist with removing barriers to getting needed services.
Conducts routine outreach to members and providers to confirm service details, coordinates services with long term services and supports teams, serves as a health plan subject matter expert and accurately documents care coordination activities.
Regular travel to conduct member visits, provider visits and community-based visits as needed to ensure effective administration of the program.
Maintain open lines of communication with enrollees, as needed based on Enrollee preferences.
Maintains accurate and timely documentation and internal systems to ensure visibility across teams and continuity of service.
Coordinates provider and member scheduling efforts, supports high-volume outreach campaigns, and ensures task completion across multiple systems.
Identify and implement effective interventions based on opportunities identified in members plan of care.
Participate in development of an individualized care plan (ICP) in collaboration with the ICT, based on member’s needs and preferences.
Educate the member/caregivers about risk conditions, community resources, insurance benefits, etc. so that timely and informed decisions can be made.
Serves as a support resource for enrollees and providers, and escalate concerns by coordinating responses and ensuring issues are routed or addressed promptly
Collaborates with clinical care managers, behavioral health clinicians, community health workers, providers, and external partners as needed to ensure smooth communication and continuity across care activities.
Gather and document service-related information during members interaction to support care coordination, service planning, or referral processes.
Maintain accurate documentation and maintenance of the centralized enrollee records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners as needed.
Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements.
Ensure enrollees follow up with providers, including assistance with appointment scheduling and verification of transportation.
Facilitate communication and information exchange with the member and their providers and community supports.
Perform any other job related duties as requested.