Care Manager Waiver (Jefferson)

Insight Global; Dayton (OH); On-site; USD 65,000 - 75,000; Full time

Job summary

Insight Global seeks a Community Based Care Coordinator to coordinate care for Medicare/Medicaid beneficiaries living at home in Ohio. You will assess medical, behavioral, and social needs and build individualized care plans while connecting members to resources and coordinating with providers.

You will work with interdisciplinary teams, conduct home visits, and monitor progress to promote safe, effective care and prevent readmissions. An RN or ASN license in Ohio is required.

Qualifications

• Must hold a current, unrestricted clinical license in Ohio (RN or ASN).
• Experience working with dual-eligible Medicare/Medicaid populations.
• Background in case management and home-based care coordination.

Responsibilities

• Coordinate care for Medicare/Medicaid eligible individuals living at home.
• Develop, implement and update individualized care plans.
• Conduct home and community-based assessments of medical, behavioral, and social needs.
• Connect members with housing, transportation, food assistance, and other services.
• Collaborate with interdisciplinary care teams and healthcare providers.
• Monitor progress, document interventions, and address barriers to care.

Skills

Nursing

Social Work

Counseling

Case Management

Care Coordination

Discharge Planning

Home Health

Community Health Management

Education

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].