Community Based Care Manager I - Indiana

CareSource

About The Position

Job Summary: The Community Based Care Manager I - Indiana collaborates with an interdisciplinary care team (ICT), healthcare providers, and community organizations. This role drives person centered coordination of care through the identification of needs and facilitation of necessary services to improve the of lives our members. Essential Functions: Collaborate with facility-based case managers and providers to create post-discharge care plans and facilitate timely transitions to appropriate levels of care. Identify and implement effective interventions based on opportunities identified in the member's post discharge care plan. Coordinate, communicate, and collaborate with members and the ICT to achieve goals and maximize positive outcomes. Facilitate regularly scheduled interdisciplinary care team (ICT) meetings as needed to address member needs. Develop and regularly update transition plans in collaboration with the ICT, based on member preferences and needs. Identify and manage barriers to achieving care plan goals. Identify and implement effective interventions based on opportunities identified in the member's post discharge care plan. Empower members to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management. Educate members, caregivers and providers about options, community resources, and benefits for informed decision-making. Evaluate member and provider satisfaction through open communication and monitoring of concerns or issues. Coordinate with community-based case managers and other service providers to ensure effective coordination and avoid duplication of services. Document care coordination activities and member responses in a timely manner according to professional standards and CareSource policies. Ensure timely transfer of member health information between providers and other MCEs as applicable Ensure timely communication of prior authorization between MCEs as applicable Continuously assess for process improvement opportunities to enhance the member and provider experience. Adhere to NCQA and CMSA standards. Perform any other job related duties as requested.

Requirements

High School or GED required
Completion of State Approved Licensed Practical Nurse Program 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
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 and federal healthcare laws and regulations and 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 and state support resources
Critical listening and thinking skills
Decision making and problem-solving skills
Strong organizational and time management skills
Current, unrestricted license as a Licensed Practical Nurse (LPN) required
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. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
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

Medicaid and/or Medicare managed care experience preferred

Responsibilities

Collaborate with facility-based case managers and providers to create post-discharge care plans and facilitate timely transitions to appropriate levels of care.
Identify and implement effective interventions based on opportunities identified in the member's post discharge care plan.
Coordinate, communicate, and collaborate with members and the ICT to achieve goals and maximize positive outcomes.
Facilitate regularly scheduled interdisciplinary care team (ICT) meetings as needed to address member needs.
Develop and regularly update transition plans in collaboration with the ICT, based on member preferences and needs.
Identify and manage barriers to achieving care plan goals.
Identify and implement effective interventions based on opportunities identified in the member's post discharge care plan.
Empower members to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management.
Educate members, caregivers and providers about options, community resources, and benefits for informed decision-making.
Evaluate member and provider satisfaction through open communication and monitoring of concerns or issues.
Coordinate with community-based case managers and other service providers to ensure effective coordination and avoid duplication of services.
Document care coordination activities and member responses in a timely manner according to professional standards and CareSource policies.
Ensure timely transfer of member health information between providers and other MCEs as applicable
Ensure timely communication of prior authorization between MCEs as applicable
Continuously assess for process improvement opportunities to enhance the member and provider experience.
Adhere to NCQA and CMSA standards.
Perform any other job related duties as requested.