Community Based Care Manager Plus

CareSource; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

CareSource is seeking a Community Based Care Manager Plus to collaborate with an inter-disciplinary care team to meet the needs of members, natural supports, and populations through culturally competent care coordination.

The role conducts health and psychosocial assessments, develops ICPs, and coordinates services to improve health outcomes with a focus on health equity. Engagement occurs across hospital, home, and community settings.

Qualifications

• Experience coordinating care with interdisciplinary teams
• Ability to conduct health and psychosocial assessments
• Skilled in health equity and culturally competent care
• Strong communication with members and caregivers

Responsibilities

• Engage the member and natural supports using strength-based assessments and trauma-informed care
• Facilitate inter-disciplinary care team (ICT) meetings to meet member needs
• Engage with members in hospital, provider office, community settings, home, or telecommunication
• Develop an ICP in collaboration with the ICT based on needs and preferences
• Identify and manage barriers to ICP goals
• Identify and implement interventions based on clinical standards and best practices
• Empower the member to manage health through effective care coordination and case management
• Coordinate and collaborate with ICT to achieve goals and positive outcomes
• Educate the member/caregivers about treatment options, resources, and benefits
• Document progress and assess ICP response
• Monitor member satisfaction and address concerns
• Verify eligibility and health status of members
• Oversee psychosocial assessments and care planning

Skills

Strength-based assessments

Trauma-informed care

Motivational interviewing

Care coordination

Interdisciplinary teamwork

Health equity

Cultural competency

Patient engagement

Job description

Job Summary:

The Community Based Care Manager Plus collaborates with members of an inter-disciplinary care team (ICT) to meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination of services and supports. Identifies needs or opportunities that would benefit from care coordination to include OhioRISE Members. The Community Based Care Manager performs the full scope of care coordination activities and responsibilities for members who need care coordination and are assigned to a CCE, the OhioRISE Plan, and/or CME, or who choose to receive care management from the MCO. The Care Manager Plus is assigned to a member when the CCE, the OhioRISE Plan, and/or the CME determine the needs of the member are greater than the capability of the entity. The MCO Care Manager and the Care Manager Plus serve as the single point of contact for care coordination.

Essential Functions:

• Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member
• Engage with the member in a variety of settings to establish an effective, professional relationship. Settings for engagement include but are not limited to hospital, provider office, community agency, member’s home, telephonic or electronic communication
• Develop an individualized, person-centered care plan (ICP) in collaboration with the ICT, based on member’s needs and preferences
• Identify and manage barriers to achievement of care plan goals
• Identify and implement effective interventions based on clinical standards and best practices
• Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management
• Facilitate coordination, communication and collaboration with the member the ICT in order to achieve goals and maximize positive member outcomes
• Educate the member/caregivers about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made
• Employ ongoing assessment and documentation to evaluate the member’s response to and progress on the ICP
• Evaluate member satisfaction through open communication and monitoring of concerns or issues
• Monitors and promotes effective utilization of healthcare resources through clinical variance and benefits management
• Verify eligibility, previous enrollment history, demographics and current health status of each member
• Completes psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholders
• Oversee (point of contact) timely psychosocial and behavioral assessments and the care planning and execution of meeting member needs