CareSource
Community Based Care Manager - Wayne County, MI - R10988-2
CareSource, Lansing, Michigan, United States
Community Based Care Manager – Wayne County, MI – R10988-2
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Community Based Care Manager – Wayne County, MI – R10988-2
role at
CareSource
Job Summary The 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 individuals, natural supports, and the population with culturally competent delivery of care, services, and supports. The manager facilitates communication, coordinates care and service through assessments, identification, and person‑centered planning, and assists members in creating and evaluating person‑centered care plans that prioritize what matters most. This includes addressing behavioral, physical, and social determinants of health with the aim to improve members’ lives.
Essential Functions
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 that identifies cultural, linguistic, social, and environmental factors shaping health.
Facilitate regularly scheduled ICT meetings to meet member needs.
Establish professional relationships with members via telephonic or electronic communication.
Develop and update individualized care plans (ICP) with the ICT based on member’s desires, needs, and preferences.
Identify and manage barriers to achieving care plan goals.
Implement interventions based on clinical standards and best practices.
Assist members in managing and improving their health, wellness, safety, adaptability, and self‑care through effective care coordination and case management.
Coordinate communication and collaboration with the member and the ICT to achieve goals and maximize positive outcomes.
Educate members and natural supports about treatment options, community resources, insurance benefits, etc., to facilitate timely and informed decisions.
Continuously assess member response and progress using ongoing assessment and documentation.
Evaluate member satisfaction through open communication and monitoring of concerns or issues.
Promote effective utilization of healthcare resources through 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 members, families, providers, and stakeholders.
Oversee timely psychosocial and behavioral assessments and care planning 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 both facility and community providers.
Identify and address gaps in care and access.
Collaborate with facility‑based healthcare professionals to plan post‑discharge care or facilitate transition to an appropriate level of care cost‑effectively.
Coordinate with community‑based organizations, state agencies, and other service providers to ensure coordination and avoid duplication of services.
Adjust programmatic intervention intensity based on guidelines and member preferences, changes in healthcare needs, and care plan progress.
Terminate care coordination services according to established case closure guidelines for members not enrolled in contractually required 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 professional standards and CareSource policies.
Continuously assess process improvements to enhance members’ experience and share findings with leadership for standardization.
Adhere to NCQA and CMSA standards.
Perform any other job duties as requested.
Education and Experience
Nursing degree from an accredited program or a bachelor’s degree in a health‑care field or equivalent relevant work experience is required.
Advanced degree with clinical licensure is preferred.
Minimum of three (3) years of experience in nursing, social work, counseling, or healthcare professions (e.g., discharge planning, case management, care coordination, home/community health management) is required.
Three (3) years of Medicaid and/or Medicare managed‑care experience is preferred.
Competencies, Knowledge and Skills
Strong understanding of quality metrics, HEDIS, disease management, medication reconciliation, and adherence.
Intermediate proficiency with Microsoft Office (Outlook, Word, Excel).
Effective communication with a diverse population.
Ability to multi‑task and work independently within a team environment.
Knowledge of local, state, and federal healthcare laws, regulations, and company policies regarding case management.
Adherence to ethical codes aligned with professional practice.
Knowledge of and adherence to CMSA standards for case management practice.
Strong advocacy for members at all care levels.
Deep understanding and sensitivity to cultural and demographic diversity.
Ability to interpret and apply 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.
Licensure and Certification
Current unrestricted clinical license in the state of practice as a Registered Nurse, Social Worker, or Professional Clinical Counselor is required. Licensure may be required in multiple states based on state requirements.
Case Management Certification is highly preferred.
Working Conditions
Must use general office equipment, including telephone, photocopier, fax machine, and personal computer.
Flexible hours, including possible evenings and/or weekends, to serve member needs.
Compensation Range $62,700.00 – $100,400.00. CareSource considers education, training, experience, role scope, complexity, discretionary latitude, and internal and external data when determining salary. In addition to base compensation, a bonus tied to company and individual performance may be available. We invest in every employee’s total well‑being and offer a comprehensive rewards package.
Compensation Type Salary.
Competencies
Fostering a Collaborative Workplace Culture – Cultivate Partnerships – Develop Self and Others – Drive Execution – Influence Others – Pursue Personal Excellence – Understand the Business.
CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Seniority Level
Mid‑Senior level
Employment Type
Full‑time
Job Function
Health Care Provider
Industry
Insurance
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Community Based Care Manager – Wayne County, MI – R10988-2
role at
CareSource
Job Summary The 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 individuals, natural supports, and the population with culturally competent delivery of care, services, and supports. The manager facilitates communication, coordinates care and service through assessments, identification, and person‑centered planning, and assists members in creating and evaluating person‑centered care plans that prioritize what matters most. This includes addressing behavioral, physical, and social determinants of health with the aim to improve members’ lives.
Essential Functions
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 that identifies cultural, linguistic, social, and environmental factors shaping health.
Facilitate regularly scheduled ICT meetings to meet member needs.
Establish professional relationships with members via telephonic or electronic communication.
Develop and update individualized care plans (ICP) with the ICT based on member’s desires, needs, and preferences.
Identify and manage barriers to achieving care plan goals.
Implement interventions based on clinical standards and best practices.
Assist members in managing and improving their health, wellness, safety, adaptability, and self‑care through effective care coordination and case management.
Coordinate communication and collaboration with the member and the ICT to achieve goals and maximize positive outcomes.
Educate members and natural supports about treatment options, community resources, insurance benefits, etc., to facilitate timely and informed decisions.
Continuously assess member response and progress using ongoing assessment and documentation.
Evaluate member satisfaction through open communication and monitoring of concerns or issues.
Promote effective utilization of healthcare resources through 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 members, families, providers, and stakeholders.
Oversee timely psychosocial and behavioral assessments and care planning 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 both facility and community providers.
Identify and address gaps in care and access.
Collaborate with facility‑based healthcare professionals to plan post‑discharge care or facilitate transition to an appropriate level of care cost‑effectively.
Coordinate with community‑based organizations, state agencies, and other service providers to ensure coordination and avoid duplication of services.
Adjust programmatic intervention intensity based on guidelines and member preferences, changes in healthcare needs, and care plan progress.
Terminate care coordination services according to established case closure guidelines for members not enrolled in contractually required 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 professional standards and CareSource policies.
Continuously assess process improvements to enhance members’ experience and share findings with leadership for standardization.
Adhere to NCQA and CMSA standards.
Perform any other job duties as requested.
Education and Experience
Nursing degree from an accredited program or a bachelor’s degree in a health‑care field or equivalent relevant work experience is required.
Advanced degree with clinical licensure is preferred.
Minimum of three (3) years of experience in nursing, social work, counseling, or healthcare professions (e.g., discharge planning, case management, care coordination, home/community health management) is required.
Three (3) years of Medicaid and/or Medicare managed‑care experience is preferred.
Competencies, Knowledge and Skills
Strong understanding of quality metrics, HEDIS, disease management, medication reconciliation, and adherence.
Intermediate proficiency with Microsoft Office (Outlook, Word, Excel).
Effective communication with a diverse population.
Ability to multi‑task and work independently within a team environment.
Knowledge of local, state, and federal healthcare laws, regulations, and company policies regarding case management.
Adherence to ethical codes aligned with professional practice.
Knowledge of and adherence to CMSA standards for case management practice.
Strong advocacy for members at all care levels.
Deep understanding and sensitivity to cultural and demographic diversity.
Ability to interpret and apply 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.
Licensure and Certification
Current unrestricted clinical license in the state of practice as a Registered Nurse, Social Worker, or Professional Clinical Counselor is required. Licensure may be required in multiple states based on state requirements.
Case Management Certification is highly preferred.
Working Conditions
Must use general office equipment, including telephone, photocopier, fax machine, and personal computer.
Flexible hours, including possible evenings and/or weekends, to serve member needs.
Compensation Range $62,700.00 – $100,400.00. CareSource considers education, training, experience, role scope, complexity, discretionary latitude, and internal and external data when determining salary. In addition to base compensation, a bonus tied to company and individual performance may be available. We invest in every employee’s total well‑being and offer a comprehensive rewards package.
Compensation Type Salary.
Competencies
Fostering a Collaborative Workplace Culture – Cultivate Partnerships – Develop Self and Others – Drive Execution – Influence Others – Pursue Personal Excellence – Understand the Business.
CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Seniority Level
Mid‑Senior level
Employment Type
Full‑time
Job Function
Health Care Provider
Industry
Insurance
#J-18808-Ljbffr