Waiver Care Coordinator (Tuscarawas/Carroll)

Insight Global (United States); Dayton (OH); On-site; USD 55,000 - 75,000; Full time

Job summary

Insight Global (United States) seeks a Community Based Care Coordinator to manage care for dual-eligible Medicare/Medicaid members in home or community settings. You’ll assess medical, behavioral, and social needs, create individualized care plans, connect members with resources, and coordinate care across providers and organizations.

In this role you will advocate for members, support transitions of care, and document interactions while complying with NCQA and CMS standards.

Qualifications

• Experience in healthcare settings coordinating patient care.
• Knowledge of Medicare/Medicaid dual-eligibles.
• Ability to conduct home visits and assess needs.
• Familiarity with NCQA and CMS standards.

Responsibilities

• Conduct comprehensive member assessments across medical, behavioral, and social needs.
• Develop and update individualized care plans.
• Meet members in homes, clinics, or community locations.
• Coordinate transitions of care and prevent readmissions.
• Connect members with housing, transportation, food, and social services.
• Document interactions and ensure care plan adherence.

Skills

Nursing

Social Work

Counseling

Case Management

Care Coordination

Discharge Planning

Home Health

Community Health Management

Job description

Job Description

DAY-TO-DAY

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 in their homes or neutral sites 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:HousingTransportationFood assistanceSocial servicesOther community-based programsEducate members and families on:Medicare and Medicaid benefitsChronic condition managementMedication adherencePreventive careAvailable healthcare and community servicesMonitor 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

Must have experience in a healthcare-related profession, such as:
NursingSocial WorkCounselingCase ManagementCare CoordinationDischarge PlanningHome HealthCommunity Health Management

Additional Requirements

Candidates must also have:
Valid driver's licenseReliable vehicleVerifiable auto insuranceAcceptable driver's license recordExperience working with dual-eligible Medicare/Medicaid populationsExperience with Medicaid and/or Medicare managed careStrong understanding of Medicare and Medicaid programsKnowledge of community resources available to high-risk or complex populationsExperience developing and managing individualized care plansExperience collaborating with interdisciplinary healthcare teamsExperience conducting assessments in members' homes or community settingsCase 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].