Community Based Care Manager - Hamilton and Butler Counties - R9306-1

CareSource; Cincinnati (OH); On-site; USD 61,000 - 99,000; Full time

Job summary

A leading company in the healthcare industry is seeking a Community Based Care Manager to coordinate services and improve the quality of care for members. The role requires collaboration with various stakeholders, assessment of member needs, and the development of personalized care plans, along with a commitment to cultural competence and effective communication.

Qualifications

• Minimum three years of relevant healthcare experience required.
• Medicaid/Medicare managed care experience preferred.
• Current unrestricted clinical license in applicable state.

Responsibilities

• Engage members and facilitate regular ICT meetings.
• Develop and update individualized care plans (ICP).
• Document activities and responses timely and according to standards.

Skills

Effective communication

Critical thinking

Organizational skills

Education

Nursing degree or Bachelor’s in healthcare field

Licensure as RN, Clinical Counselor, or Social Worker

Advanced degree preferred

Tools

Microsoft Office

Job description

Community Based Care Manager - Hamilton and Butler Counties - R9306-1

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Job Summary

The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports, and the population through culturally competent care delivery and coordination of services and supports. Facilitates communication, coordinates care and services for the member through assessments, planning, and assists in creating and evaluating person-centered care plans to address behavioral, physical, and social health needs, aiming to improve members' lives.

Essential Functions

• Engage members and their natural support systems using strength-based assessments and trauma-informed care approaches, including motivational interviewing, to identify cultural, linguistic, social, and environmental factors affecting health and disparities.
• Facilitate regular ICT meetings to coordinate care.
• Engage with members in various settings such as hospitals, clinics, community agencies, homes, or via telecommunication.
• Develop and update individualized care plans (ICP) based on members' preferences and needs.
• Identify and address barriers to care plan goals.
• Implement effective interventions based on clinical standards.
• Empower members to manage their health through care coordination and case management.
• Coordinate with ICT to achieve member goals and outcomes.
• Educate members and supports about treatment options, resources, and benefits.
• Continuously assess and document member responses and progress.
• Evaluate member satisfaction and address concerns.
• Monitor healthcare resource utilization and benefits management.
• Verify member eligibility, history, demographics, and health status.
• Oversee psychosocial and behavioral assessments and care planning.
• Participate in provider meetings to inform about services and benefits.
• Assist with provider orientation and training regarding ICDs model of care.
• Identify and address gaps in care and access.
• Coordinate post-discharge care and transitions.
• Collaborate with community organizations and agencies to ensure coordinated services.
• Adjust intervention intensity based on guidelines, member preferences, and care plan progress.
• Terminating care services as per case closure guidelines when appropriate.
• Provide clinical oversight to unlicensed team members.
• Document activities and responses timely and according to standards.
• Seek process improvements to enhance member experience.
• Travel regularly to conduct member, provider, and community visits.
• Adhere to NCQA and CMSA standards.
• Perform other duties as assigned.

Education and Experience

• Nursing degree or Bachelor’s in healthcare field or equivalent experience required.
• Licensure as RN, Clinical Counselor, or Social Worker required.
• Advanced degree preferred.
• Minimum three years of relevant healthcare experience required.
• Medicaid/Medicare managed care experience preferred.

Competencies, Knowledge, and Skills

• Understanding of quality metrics, disease management, medication adherence.
• Proficiency with Microsoft Office tools.
• Effective communication with diverse individuals.
• Ability to multitask and work independently.
• Knowledge of healthcare laws, regulations, and policies.
• Adherence to ethical standards and CMSA practices.
• Advocacy skills, cultural sensitivity, research interpretation, community resource awareness.
• Critical thinking, decision-making, organizational skills.

Licensure and Certification

• Current unrestricted clinical license in applicable state.
• Case Management Certification preferred.
• Valid driver’s license, vehicle, and insurance required.
• Influenza vaccination required during flu season.

Working Conditions

• Travel required; must reside in the assigned territory.
• May travel over 50% of the time.
• Use of standard office equipment.
• Flexible hours, including evenings/weekends as needed.

Compensation Range

$61,500 - $98,400, plus potential bonuses and benefits.

Employment Details

• Full-time, Mid-Senior level, in the health care provider industry.

This job description is subject to change. CareSource is an Equal Opportunity Employer.