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CareSource · 5 months ago

Community Based Care Manager - RN or SW - Nevada

Las Vegas, NV

Full-time

Hybrid

Mid Level

$62K/yr - $98K/yr

3+ years exp

CareSource is a healthcare organization dedicated to improving the quality of care for its members. The Community Based Care Manager is responsible for collaborating with an inter-disciplinary care team to provide culturally competent care and coordination of services, ensuring the individual needs of members are met through effective communication and support.

Health CareMedicalNon Profit

Comp. & Benefits

Responsibilities

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 and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on member’s desires, 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/ natural supports 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

Participate in meetings with providers to inform them of Care Management services and benefits available to members

Assists with ICDS model of care orientation and training of both facility and community providers

Identify and address gaps in care and access

Collaborate with facility-based healthcare professionals and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner

Coordinate with community-based organizations, state agencies and other service providers to ensure coordination and avoid duplication of services

Adjust the intensity of programmatic interventions provided to member based on established guidelines and in accordance with the member’s preferences, changes in special healthcare needs, and care plan progress

Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required ongoing care coordination

Provide clinical oversight and direction to unlicensed team members as appropriate

Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation

Continuously assess for areas to improve the process to make the members experience with CareSource easier and shares with leadership to make it a standard, repeatable process

Regular travel to conduct member, provider and community-based visits as needed to ensure effective administration of the program

Adherence to NCQA and CMSA standards

Perform any other job duties as requested

Qualification

Registered Nurse LicensureCase Management CertificationMedicaid/Medicare ExperienceMicrosoft Office ProficiencyClinical OversightCultural SensitivityCommunication SkillsOrganizational SkillsProblem-Solving SkillsTeam Collaboration

Required

Nursing degree from an accredited nursing program or Bachelor's degree in a health care field or equivalent years of relevant work experience is required

Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is required

A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required

Current unrestricted clinical license in state of practice as a Registered Nurse, Social Worker or Clinical Counselor is required. Licensure may be required in multiple states as applicable based on State requirement of the work assigned

Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check and verified insurance

To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified