TrueCare
Overview
Community Based Care Managers - R10607 role at TrueCare. 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.
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.
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.
Facilitate coordination, communication and collaboration with the member and the ICT to achieve goals and maximize positive outcomes.
Educate the member and natural supports about treatment options, community resources, insurance benefits, etc., so timely and informed decisions can be made.
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, 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 to meet 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 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 facilitate 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 healthcare needs, and care plan progress.
Appropriately terminate care coordination services based on established case closure guidelines for members not enrolled in ongoing care coordination.
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 opportunities to improve the member experience and share with leadership to standardize processes.
Travel as needed to conduct member, provider and community-based visits to ensure effective administration of the program.
Adhere to NCQA and CMSA standards.
Perform other job 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 work experience.
Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is required.
Advanced degree related to clinical licensure is preferred.
Minimum of three (3) years of experience in nursing or social work or counseling or health care profession (e.g., discharge planning, case management, care coordination, home/community health management).
Three (3) years Medicaid and/or Medicare managed care experience is preferred.
Competencies, Knowledge And Skills
Strong understanding of quality, HEDIS, disease management, and medication reconciliation and adherence.
Intermediate proficiency with Microsoft Office (Outlook, Word, Excel).
Effective communication with a diverse group of individuals.
Ability to multi-task and work independently within a team.
Knowledge of local, state and federal healthcare laws and regulations and company policies regarding case management practices.
Adherence to code of ethics and CMSA standards for case management.
Strong advocacy for members at all levels of care and sensitivity to diverse cultures and demographics.
Ability to interpret and implement current research findings.
Awareness of community and state support resources.
Critical thinking, decision making 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 checks may apply.
Influenza vaccination is a requirement for designated positions during influenza season (Oct 1 – Mar 31); proof of vaccination may be required.
CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions as required by law.
Working Conditions
Mobile position with regular travel to different work locations, including homes, offices or other settings.
Must reside in the assigned territory.
Travel may exceed 50% of the time.
Flexible hours, including possible evenings and weekends as needed.
Compensation $55,350.00 - $88,560.00. CareSource considers education, training, experience and other factors when establishing salary. Bonus potential and a comprehensive total rewards package are offered.
Employment Type Full-time
Job Function
Health Care Provider
Industries
Insurance
#J-18808-Ljbffr
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.
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.
Facilitate coordination, communication and collaboration with the member and the ICT to achieve goals and maximize positive outcomes.
Educate the member and natural supports about treatment options, community resources, insurance benefits, etc., so timely and informed decisions can be made.
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, 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 to meet 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 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 facilitate 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 healthcare needs, and care plan progress.
Appropriately terminate care coordination services based on established case closure guidelines for members not enrolled in ongoing care coordination.
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 opportunities to improve the member experience and share with leadership to standardize processes.
Travel as needed to conduct member, provider and community-based visits to ensure effective administration of the program.
Adhere to NCQA and CMSA standards.
Perform other job 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 work experience.
Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is required.
Advanced degree related to clinical licensure is preferred.
Minimum of three (3) years of experience in nursing or social work or counseling or health care profession (e.g., discharge planning, case management, care coordination, home/community health management).
Three (3) years Medicaid and/or Medicare managed care experience is preferred.
Competencies, Knowledge And Skills
Strong understanding of quality, HEDIS, disease management, and medication reconciliation and adherence.
Intermediate proficiency with Microsoft Office (Outlook, Word, Excel).
Effective communication with a diverse group of individuals.
Ability to multi-task and work independently within a team.
Knowledge of local, state and federal healthcare laws and regulations and company policies regarding case management practices.
Adherence to code of ethics and CMSA standards for case management.
Strong advocacy for members at all levels of care and sensitivity to diverse cultures and demographics.
Ability to interpret and implement current research findings.
Awareness of community and state support resources.
Critical thinking, decision making 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 checks may apply.
Influenza vaccination is a requirement for designated positions during influenza season (Oct 1 – Mar 31); proof of vaccination may be required.
CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions as required by law.
Working Conditions
Mobile position with regular travel to different work locations, including homes, offices or other settings.
Must reside in the assigned territory.
Travel may exceed 50% of the time.
Flexible hours, including possible evenings and weekends as needed.
Compensation $55,350.00 - $88,560.00. CareSource considers education, training, experience and other factors when establishing salary. Bonus potential and a comprehensive total rewards package are offered.
Employment Type Full-time
Job Function
Health Care Provider
Industries
Insurance
#J-18808-Ljbffr