COMMUNITY BASED CARE MANAGER - RN - FRANKLIN COUNTY

$60,300 - $96,500/Yr

CareSource - Columbus, OH

Full-time - Mid Level

Columbus, OH

Ambulatory Health Care Services

About the position

The Community Based Care Manager plays a crucial role in collaborating with an inter-disciplinary care team (ICT), healthcare providers, and community organizations to enhance the quality of care and meet the diverse needs of individuals and populations. This position emphasizes culturally competent care delivery and coordination of services, ensuring that members receive the support they need to improve their health outcomes. The Care Manager is responsible for facilitating communication among team members, conducting assessments, and developing person-centered care plans that prioritize the unique needs of each member, including behavioral, physical, and social determinants of health. In this role, the Care Manager engages with members and their natural support systems through strength-based assessments and a trauma-informed care approach. Utilizing motivational interviewing techniques, the Care Manager conducts health and psychosocial assessments that consider cultural, linguistic, social, and environmental factors affecting health. Regularly scheduled ICT meetings are facilitated to ensure that the care plan aligns with the member's desires and needs. The Care Manager also identifies and manages barriers to achieving care plan goals, implements effective interventions based on clinical standards, and empowers members to take charge of their health and wellness. The position requires ongoing assessment and documentation of the member's progress, satisfaction, and response to the individualized care plan (ICP). The Care Manager educates members and their support systems about treatment options, community resources, and insurance benefits, enabling informed decision-making. Additionally, the role involves monitoring healthcare resource utilization, verifying member eligibility, and conducting psychosocial and behavioral assessments. The Care Manager collaborates with facility-based case managers and community service providers to ensure seamless transitions of care and to address any gaps in services. This mobile position necessitates regular travel to meet with members, providers, and community organizations, ensuring effective program administration. Adherence to NCQA standards and other regulatory requirements is essential, as is the ability to adapt to the dynamic needs of the members served. The Care Manager is expected to maintain a high level of professionalism and ethical standards while advocating for members at all levels of care.

Responsibilities

• Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach.
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member.
• Develop 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.
• 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 member outcomes.
• 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 case managers and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care.
• Coordinate with community-based case managers and other service providers to ensure coordination and avoid duplication of services.
• Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation.
• Continuously assess for areas to improve the process to make the member's experience with CareSource easier and share with leadership to make it a standard, repeatable process.
• Conduct regular travel to conduct member, provider, and community-based visits as needed.

Requirements

• Nursing degree from an accredited nursing program or Bachelor's degree in a health care field or equivalent years of relevant work experience is required.
• Licensure as a Registered Nurse, Professional Clinical Counselor, or Social Worker is required.
• A minimum of three (3) years of experience in nursing, social work, counseling, or healthcare profession (i.e., discharge planning, case management, care coordination, and/or home/community health management experience) is required.
• 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.

Nice-to-haves

• Advanced degree associated with clinical licensure is preferred.
• Case Management Certification is highly preferred.

Benefits

• Comprehensive total rewards package including health insurance, retirement plans, and paid time off.
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of members.
• Support for ongoing education and professional development opportunities.