Community Based Care Manager - Hamilton and Butler Counties - R9306-2

CareSource; Ohio; On-site; USD 61,000 - 99,000; Full time

Job summary

A leading health care provider is seeking a Community Based Care Manager for Hamilton and Butler Counties. This role is essential for coordinating care and improving health outcomes by working closely with members and community organizations. Ideal candidates will have a nursing or equivalent degree, relevant licensure, and experience in Medicaid or Medicare managed care.

Qualifications

• Minimum 3 years in nursing, social work, counseling, or healthcare roles.
• Active unrestricted clinical license required.
• Case Management Certification preferred.

Responsibilities

• Collaborates with inter-disciplinary care team to improve member quality and needs.
• Develops individualized care plans based on member preferences.
• Conducts health and psychosocial assessments.

Skills

Effective communication

Critical thinking

Organizational skills

Cultural sensitivity

Education

Nursing degree or Bachelor’s in healthcare

Licensure as RN, Clinical Counselor, or Social Worker

Tools

Microsoft Office

Job description

Community Based Care Manager - Hamilton and Butler Counties - R9306-2

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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 delivery of care and coordination of services and supports. Facilitates communication, coordinates care and services of the member through assessments, identification, and planning, and assists the member in creating and evaluating person-centered care plans to prioritize and address what matters most, behavioral, physical, and social determinants of health needs, with the aim to improve the lives of our members.

Essential Functions

• Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivational interviewing to complete health and psychosocial assessments through a health equity lens, considering cultural, linguistic, social, and environmental factors that shape health and access to care.
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to address the needs of the member.
• Engage with the member in various settings, including hospitals, provider offices, community agencies, the member’s home, telephonic, or electronic communication, to establish effective, professional relationships.
• Develop and update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on the member’s desires, needs, and preferences.
• Identify and manage barriers to achieving care plan goals.
• Implement effective interventions based on clinical standards and best practices.
• Empower the member to manage and improve their health, wellness, safety, and self-care through care coordination and case management.
• Coordinate, communicate, and collaborate with the member and ICT to achieve goals and maximize positive outcomes.
• Educate the member and natural supports about treatment options, community resources, insurance benefits, etc., for informed decision-making.
• Continuously assess and document the member’s response to and progress on the ICP.
• Evaluate member satisfaction through open communication and monitor concerns or issues.
• Promote effective utilization of healthcare resources through clinical variance and benefits management.
• Verify eligibility, enrollment history, demographics, and current health status of each member.
• Complete psychosocial and behavioral assessments by gathering information from the member, family, provider, and stakeholders.
• Oversee timely psychosocial and behavioral assessments and care planning.
• Participate in meetings with providers to inform them of Care Management services and benefits.
• Assist with ICDS model orientation and training of facility and community providers.
• Identify and address gaps in care and access.
• Collaborate with healthcare professionals to plan post-discharge care or facilitate timely, cost-effective transitions.
• Coordinate with community organizations, state agencies, and service providers to ensure seamless care and avoid duplication.
• Adjust intervention intensity based on guidelines, member preferences, and care plan progress.
• Terminate care services appropriately based on case closure guidelines.
• Provide clinical oversight to unlicensed team members as appropriate.
• Document activities and responses timely according to standards and policies.
• Seek continuous process improvements to enhance member experience.
• Travel regularly to conduct member, provider, and community visits as needed.
• Adhere to NCQA and CMSA standards.
• Perform other duties as requested.

Education and Experience

• Nursing degree or Bachelor’s in healthcare or equivalent experience.
• Licensure as RN, Clinical Counselor, or Social Worker required.
• Advanced clinical degree preferred.
• Minimum 3 years in nursing, social work, counseling, or healthcare roles.
• Experience with Medicaid and/or Medicare managed care preferred.

Skills and Competencies

• Understanding of quality metrics, disease management, medication reconciliation, and adherence.
• Proficiency in Microsoft Office.
• Effective communication with diverse individuals.
• Ability to multi-task and work independently and in teams.
• Knowledge of healthcare laws, regulations, and ethical standards.
• Advocacy skills and cultural sensitivity.
• Research interpretation and community resource awareness.
• Critical thinking, decision-making, and organizational skills.

Licensure and Certification

• Active unrestricted clinical license in the state of practice.
• Case Management Certification preferred.
• Valid driver’s license, vehicle, and insurance required.
• Influenza vaccination required annually during flu season.

Working Conditions

• Mobile role involving travel to various locations, including members’ homes.
• Residence in the assigned territory required.
• 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, with potential bonuses and comprehensive benefits.

Additional Information

This is a mid-senior level, full-time health care provider role within the insurance industry. CareSource is an equal opportunity employer committed to diversity and inclusion.