Care Manager (Mercer)

Insight Global; Dayton (OH); On-site; USD 65,000 - 85,000; Full time

Job summary

Insight Global is seeking a Community Based Care Coordinator to coordinate care for Medicare/Medicaid dual-eligible individuals in and around Dayton, OH. You will perform home and community visits, assess needs, and develop personalized care plans in collaboration with interdisciplinary teams.

The role requires an Ohio license in a clinical field (RN/ Social Work / Counseling) and experience with Medicaid/Medicare programs, managed care, and care coordination.

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
• Valid driver's license and reliable vehicle
• Verifiable auto insurance
• Experience with dual-eligible Medicare/Medicaid populations
• Experience with Medicaid and/or Medicare managed care
• Knowledge of Medicare and Medicaid programs
• Experience developing and managing individualized care plans
• Case Management Certification preferred

Responsibilities

• Coordinate care for individuals eligible for Medicare and Medicaid living in long-term care facilities.
• Assess medical, behavioral, and social needs and develop individualized care plans.
• Connect members with resources and coordinate care across providers and organizations.
• Lead interdisciplinary care teams and coordinate transitions of care to prevent readmissions.
• Educate members and families on benefits, chronic condition management, and preventive care.
• Maintain documentation of interactions, plans, interventions, and outcomes.
• Advocate for members and ensure active participation in healthcare decisions.

Skills

Nursing

Social Work

Counseling

Case Management

Care Coordination

Discharge Planning

Home Health

Community Health

Education

RN license

MSN

MSW

MS in Clinical Counseling

Job description

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.

Main 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:HousingTransportationFood assistanceSocial servicesOther community-based programsEducate members and families on:Medicare and Medicaid benefitsChronic condition managementMedication adherencePreventive careAvailable healthcare and community servicesMonitor 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

Skills and Requirements

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

Registered Nurse (RN)ASNSocial WorkerMastersClinical CounselorMasters

Experience

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

NursingSocial WorkCounselingCase ManagementCare CoordinationDischarge PlanningHome HealthCommunity Health Management

Additional Requirements

Candidates must also have:

Valid driver's licenseReliable vehicleVerifiable auto insuranceAcceptable driver's license recordExperience working with dual-eligible Medicare/Medicaid populationsExperience with Medicaid and/or Medicare managed careStrong understanding of Medicare and Medicaid programsKnowledge of community resources available to high-risk or complex populationsExperience developing and managing individualized care plansExperience collaborating with interdisciplinary healthcare teamsExperience conducting assessments in members' homes or community settingsCase Management Certification, highly preferred

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [e-mail].