CareSource
Healthcare
CommunityBasedCareManager
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Community Based Care Manager at CareSource. Skills: Care management, Member engagement, Care plan development. Collaborate with inter-disciplinary care team. Improve quality and meet member needs”
What You'll Achieve.
Improve quality; Meet member needs; Improve health disparities; Improve access to care; Achieve goals; Maximize positive member outcomes; Ensure coordination; Avoid duplication of services; Ensure effective administration
Industry & Context.
Identify and manage barriers; Identify and implement interventions; Identify and address gaps
Regular travel, Driver's license, Influenza vaccination, Travel greater than 50%
What They're Looking For.
Must Have
Nursing degree or Bachelor's degree, Registered Nurse, Professional Clinical Counselor or Social Worker licensure, 3+ years experience in nursing, social work, counseling, or health care profession, 3+ years Medicaid and/or Medicare managed care experience
Nice to Have
Advanced degree associated with clinical licensure, 3 years Medicaid and/or Medicare managed care experience
What You'll Do.
Collaborate with inter-disciplinary care team
Improve quality and meet member needs
Deliver culturally competent care
Coordinate services and supports
Facilitate communication
Coordinate care and service
Complete health and psychosocial assessments
and environmental factors
Improve health disparities and access
Facilitate inter-disciplinary care team meetings
Engage member in various settings
Develop person-centered individualized care plan
Identify and manage barriers
Implement effective interventions
Empower member to manage health
Coordinate and communicate with ICT
Educate member about treatment options
Educate member about community resources
Educate member about insurance benefits
Evaluate member's response to ICP
Evaluate member satisfaction
Monitor concerns or issues
Promote effective utilization of healthcare resources
Verify member eligibility
Verify member enrollment history
Verify member demographics
Verify member health status
Complete psychosocial and behavioral assessments
Gather information from member
Oversee psychosocial and behavioral assessments
Oversee care planning
Oversee execution of meeting member needs
Participate in meetings with providers
Inform providers of Care Management services
Assist with ICDS model of care orientation
Assist with training for providers
Identify and address gaps in care
Identify and address gaps in access
Collaborate with facility-based professionals
Plan for post-discharge care needs
Facilitate transition to appropriate care level
Coordinate with community-based organizations
Coordinate with state agencies
Coordinate with other service providers
Avoid duplication of services
Adjust intensity of programmatic interventions
Terminate care coordination services
Provide clinical oversight to unlicensed team members
Document care coordination activities
Document member response
Improve process for member experience
Share process improvements with leadership
Conduct member visits
Conduct provider visits
Conduct community-based visits
Adhere to NCQA standards
Adhere to CMSA standards
Perform other job duties as requested
How You'll Work.
Team & Collaboration
Interdisciplinary care team; Facility-based healthcare professionals; Community-based organizations
Communication Scope
Effective communication
Full Job Description
**Job Summary:** 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 of lives our members. **Essential Functions:** * Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and 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. Settings for engagement include but are not limited to 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’s 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 ef
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