Care Manager Waiver (Highland)

Insight Global; Dayton (OH); On-site; USD 60,000 - 90,000; Full time

Job summary

Insight Global is seeking a Community Based Care Coordinator in Dayton, OH to assess medical, behavioral and social needs of dual-eligible individuals. You will develop personalized care plans and connect members with community resources, meeting them in homes or other settings.

This role requires an Ohio clinical license (RN or ASN), healthcare experience, and collaboration with physicians, social workers, and state agencies.

Qualifications

• Must hold a current, unrestricted Ohio clinical license (RN or ASN).
• Experience in healthcare roles such as nursing, social work, counseling, case management, or home health.

Responsibilities

• Conduct comprehensive member assessments to identify medical, behavioral health, and social needs.
• Develop, implement, and update individualized care plans.
• Meet with members in homes, healthcare settings, offices, and community locations.
• Coordinate care among members, providers, and community organizations.
• Lead 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 Medicare, Medicaid benefits, chronic condition management, and preventive care.
• Monitor progress and adherence to the care plan.
• Document interactions, care plans, interventions, and outcomes.
• Identify barriers to care and report suspected abuse or neglect as required.
• Maintain compliance with NCQA and CMSA standards.

Skills

Care coordination

Case management

Discharge planning

Home visits

Education

Ohio license (RN or ASN)

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 at home 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:
  • Housing
  • Transportation
  • Food assistance
  • Social services
  • Other community-based programs
• Educate members and families on:
  • Medicare and Medicaid benefits
  • Chronic condition management
  • Medication adherence
  • Preventive care
  • 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

Skills and Requirements

Licensure

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

• Registered Nurse (RN)
• ASN

Experience

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

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

Additional Requirements

Candidates must also have:

• Valid driver's license
• Reliable vehicle
• Verifiable auto insurance
• Acceptable driver's license record
• 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

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].