CareSource
Community Based Care Manager - Wayne County - R9660-3
CareSource, Lansing, Michigan, United States
Overview
Community Based Care Manager - RN - Greater Detroit Area - R9660-3 at CareSource. The role 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. The Care Manager facilitates communication, coordinates care and services through assessments, identification and planning, and assists the member in creation and evaluation of person-centered care plans to prioritize what matters most, addressing behavioral, physical and social determinants of health to improve lives. Responsibilities
Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivational interviewing to complete health and psychosocial assessments through a health equity lens, identifying cultural, linguistic, social and environmental factors that shape health and disparities in 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 (hospital, provider office, community agency, member’s home, telephonic or electronic communication) Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on member 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 Coordinate, communicate and collaborate with the member and ICT to achieve goals and maximize positive outcomes Educate the member and natural supports about treatment options, community resources, insurance benefits, etc. for timely and informed decisions Ongoing assessment and documentation to evaluate the member’s response to and progress on the ICP Evaluate member satisfaction and monitor concerns or issues Promote efficient utilization of healthcare resources through clinical variance and benefits management Verify eligibility, enrollment history, demographics and current health status Complete psychosocial and behavioral assessments by gathering information from the member, family, providers and other stakeholders Oversee timely psychosocial and behavioral assessments and care planning and execution to meet member needs Participate in meetings with providers to inform them of Care Management services and benefits Assist with ICDS model of care orientation and training of 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 or transition to an appropriate level of care in a timely and cost-effective manner Coordinate with community-based organizations, state agencies and other service providers to ensure coordination and avoid duplication of services Adjust the intensity of programmatic interventions based on guidelines and member preferences, changes in needs and care plan progress Terminate care coordination services based on established case closure guidelines for members not enrolled in ongoing coordinated care 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 Continuously assess for process improvements to enhance the member experience Regular travel to conduct member, provider and community-based visits as needed Adherence to NCQA and CMSA standards Perform other 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 experience Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker Advanced degree associated with clinical licensure is preferred 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 Competencies, Knowledge And Skills
Strong understanding of Quality, HEDIS, disease management, medication reconciliation and adherence Proficiency with Microsoft Office (Outlook, Word, Excel) Effective communication with diverse groups Ability to multi-task and work independently within a team Knowledge of healthcare laws and regulations and company policies on case management Adherence to ethics and CMSA standards for case management Strong advocacy for members and sensitivity to cultural diversity Ability to interpret and apply current research Awareness of community and state support resources Critical listening and problem-solving skills Strong organizational and time management skills Licensure And Certification
Current unrestricted clinical license in state of practice (RN, Social Worker, or Clinical Counselor). Multi-state licensure as applicable Case Management Certification is highly preferred Must have valid driver’s license, vehicle and verifiable insurance; driving record clearance required Influenza vaccination is a condition of continued employment during influenza season CareSource provides accommodations as required by law; accommodations processed via interactive review Working Conditions
Mobile position with regular travel to different work locations, including homes and community settings Must reside in the assigned territory; travel may exceed 50% as needed May require flexible hours, including evenings and weekends Compensation
$61,500.00 - $98,400.00. CareSource considers education, training and experience, role scope and complexity, and other data when establishing salary. Eligible for bonus tied to performance. Comprehensive total rewards package. Compensation Type: Salary Additional Information
This job description is not all-inclusive. CareSource reserves the right to amend the job description. CareSource is an Equal Opportunity Employer. We are committed to fostering an inclusive environment for individuals of all backgrounds.
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Community Based Care Manager - RN - Greater Detroit Area - R9660-3 at CareSource. The role 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. The Care Manager facilitates communication, coordinates care and services through assessments, identification and planning, and assists the member in creation and evaluation of person-centered care plans to prioritize what matters most, addressing behavioral, physical and social determinants of health to improve lives. Responsibilities
Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivational interviewing to complete health and psychosocial assessments through a health equity lens, identifying cultural, linguistic, social and environmental factors that shape health and disparities in 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 (hospital, provider office, community agency, member’s home, telephonic or electronic communication) Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on member 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 Coordinate, communicate and collaborate with the member and ICT to achieve goals and maximize positive outcomes Educate the member and natural supports about treatment options, community resources, insurance benefits, etc. for timely and informed decisions Ongoing assessment and documentation to evaluate the member’s response to and progress on the ICP Evaluate member satisfaction and monitor concerns or issues Promote efficient utilization of healthcare resources through clinical variance and benefits management Verify eligibility, enrollment history, demographics and current health status Complete psychosocial and behavioral assessments by gathering information from the member, family, providers and other stakeholders Oversee timely psychosocial and behavioral assessments and care planning and execution to meet member needs Participate in meetings with providers to inform them of Care Management services and benefits Assist with ICDS model of care orientation and training of 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 or transition to an appropriate level of care in a timely and cost-effective manner Coordinate with community-based organizations, state agencies and other service providers to ensure coordination and avoid duplication of services Adjust the intensity of programmatic interventions based on guidelines and member preferences, changes in needs and care plan progress Terminate care coordination services based on established case closure guidelines for members not enrolled in ongoing coordinated care 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 Continuously assess for process improvements to enhance the member experience Regular travel to conduct member, provider and community-based visits as needed Adherence to NCQA and CMSA standards Perform other 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 experience Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker Advanced degree associated with clinical licensure is preferred 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 Competencies, Knowledge And Skills
Strong understanding of Quality, HEDIS, disease management, medication reconciliation and adherence Proficiency with Microsoft Office (Outlook, Word, Excel) Effective communication with diverse groups Ability to multi-task and work independently within a team Knowledge of healthcare laws and regulations and company policies on case management Adherence to ethics and CMSA standards for case management Strong advocacy for members and sensitivity to cultural diversity Ability to interpret and apply current research Awareness of community and state support resources Critical listening and problem-solving skills Strong organizational and time management skills Licensure And Certification
Current unrestricted clinical license in state of practice (RN, Social Worker, or Clinical Counselor). Multi-state licensure as applicable Case Management Certification is highly preferred Must have valid driver’s license, vehicle and verifiable insurance; driving record clearance required Influenza vaccination is a condition of continued employment during influenza season CareSource provides accommodations as required by law; accommodations processed via interactive review Working Conditions
Mobile position with regular travel to different work locations, including homes and community settings Must reside in the assigned territory; travel may exceed 50% as needed May require flexible hours, including evenings and weekends Compensation
$61,500.00 - $98,400.00. CareSource considers education, training and experience, role scope and complexity, and other data when establishing salary. Eligible for bonus tied to performance. Comprehensive total rewards package. Compensation Type: Salary Additional Information
This job description is not all-inclusive. CareSource reserves the right to amend the job description. CareSource is an Equal Opportunity Employer. We are committed to fostering an inclusive environment for individuals of all backgrounds.
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