Care Manager

Insight Global; Ohio; On-site; USD 70,000 - 90,000; Full time

Job summary

Insight Global is seeking a Community Based Care Coordinator in Ohio to coordinate care for individuals eligible for Medicare and Medicaid. This role works with members in long-term care facilities to assess medical, behavioral, and social needs, develop individualized care plans, connect members with resources, and coordinate care across providers and community organizations.

You will work with interdisciplinary teams to coordinate member care, educate members and families on benefits and

Qualifications

• Must hold a current Ohio clinical license (RN, Social Worker, Counselor or related licensure).
• Experience in case management, care coordination or home health is preferred.

Responsibilities

• Conduct comprehensive member assessments to identify medical, behavioral health, functional, and social needs.
• Develop, implement, and regularly update individualized care plans.
• Meet with members in homes, healthcare settings, offices, and community locations.
• Lead and collaborate with interdisciplinary care teams to coordinate member care.
• Coordinate transitions of care and follow up after hospitalizations to prevent readmissions.
• Connect members with housing, transportation, food assistance and other community resources.
• Educate members and families on benefits, chronic condition management, medication adherence, and available services.
• Monitor member progress and adherence to the care plan.
• Maintain accurate documentation of interactions, plans, interventions, and outcomes.

Skills

Care coordination

Interdisciplinary collaboration

Patient advocacy

Assessment skills

Communication

Home visits

Education

Registered Nurse (RN) license

ASN

MSW / Social Worker

Master’s degree in related field

Clinical Counselor license

Job description

The Community Based Care Coordinator is responsible for coordinating care for individuals who are eligible for both Medicare and Medicaid. This role works directly with members living in longer term care facilities to assess medical, behavioral, and social needs, develop individualized care plans, connect members with resources, and coordinate care across providers and community organizations.

Responsibilities

• Conduct comprehensive member assessments to identify medical, behavioral health, functional, and social needs.
• Develop, implement, and regularly update individualized care plans.
• Meet with members in their homes, healthcare settings, offices, and other community locations.
• Serve as a liaison between members, healthcare providers, community organizations, and other service agencies.
• Lead and collaborate with interdisciplinary care teams (ICTs) to coordinate member care.
• Coordinate transitions of care and follow up after hospitalizations or significant health events to help prevent readmissions.
• Connect members with community resources, including:
  • Housing
  • Transportation
  • Food assistance
  • Other community-based programs
• Educate members and families on:
  • Medicare and Medicaid benefits
  • Chronic condition management
  • Medication adherence
  • Available healthcare and community services
• Monitor member progress, health status, and adherence to the care plan.
• Collaborate with physicians, specialists, behavioral health providers, state agencies, and community-based organizations.
• Advocate for members and encourage active participation in healthcare decisions.
• Maintain accurate documentation of member interactions, care plans, interventions, and outcomes.
• Identify and address barriers to care.
• Report suspected abuse, neglect, or exploitation as a mandated reporter when required.
• Maintain compliance with applicable NCQA and CMSA standards.

Qualifications

Must have a current, unrestricted clinical license in Ohio as one of the following:

• Registered Nurse (RN)
• ASN
• Social Worker
• Masters
• Clinical Counselor
• Masters

Experience

Must have experience in a healthcare-related profession, such as:

• Nursing
• Social Work
• Counseling
• Case Management
• Care Coordination
• Home Health
• Community Health Management

Preferred Skills

• Experience working with dual-eligible Medicare/Medicaid populations
• Experience with Medicaid and/or Medicare managed care
• Strong understanding of Medicare and Medicaid programs
• Knowledge of community resources available to high-risk or complex populations
• Experience developing and managing individualized care plans
• Experience collaborating with interdisciplinary healthcare teams
• Experience conducting assessments in members' homes or community settings
• Case Management Certification, highly preferred