Community Based Care Manager - Stark and/or Summit Counties

CareSource-posted 6 months ago
$61,500 - $98,400/Yr
Full-time • Mid Level
Cleveland, OH
Ambulatory Health Care Services
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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.

  • Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing.
  • Complete health and psychosocial assessments through a health equity lens unique to the needs of each member.
  • 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.
  • 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 through clinical variance and benefits management.
  • 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.
  • 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 make the members experience with CareSource easier.
  • Regular travel to conduct member, provider and community-based visits as needed.
  • Adhere to NCQA and CMSA standards.
  • Nursing degree from an accredited nursing program or Bachelor's degree in a health care field or equivalent years of relevant work experience.
  • Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker.
  • A minimum of three (3) years of experience in nursing or social work or counseling or health care profession.
  • Three (3) years Medicaid and/or Medicare managed care experience is preferred.
  • 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 & federal healthcare laws and regulations & 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 & state support resources.
  • Critical listening and thinking skills.
  • Decision making and problem-solving skills.
  • Strong organizational and time management skills.
  • Advanced degree associated with clinical licensure.
  • Case Management Certification is highly preferred.
  • Comprehensive total rewards package including base compensation and potential bonuses tied to performance.
  • Flexible hours, including possible evenings and/or weekends as needed.
  • Reasonable accommodations for qualified individuals with disabilities or medical conditions.
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