CommuniCare Advantage · 1 day ago
Health Plan Care Manger
Dayton, OH
Full-time
Onsite
Mid, Senior Level
3+ years expCommuniCare Advantage is focused on delivering quality healthcare services, and they are seeking a Care Manager to coordinate member care and develop actionable care plans. The role involves collaboration with an interdisciplinary team to ensure high-quality healthcare services are provided to members in an institutional setting.
Elder CareHealth CareHealth InsuranceInsurance
Hiring Manager
Lizzy Hull
Responsibilities
Oversee and coordinate the care of assigned ISNP members, ensuring they receive timely and appropriate care as dictated by the SNP Model of Care
Performs initial, annual, transition of care (TOC) and change in condition health risk assessments (HRA) for ISNP care managed caseload
Formulates and implements a member centric holistic care plan that addresses identified needs by assessing the member/representative/family needs, issues, resources and care goals; determining and educating on the choices available to the individual member
Collaborates with the interdisciplinary team (ICT) which may include Medical Director, PCP, nurse practitioners/physician assistants, pharmacy, dietary, social workers, other clinical and non-clinical disciplines, facility staff, member representatives and family to establish, revise and continuously evaluate the member centric care plan and conduct documented interdisciplinary care team meetings
Provide education to members and their families about managing chronic conditions and promotion of self-management strategies
Maintain accurate and timely documentation of member care activities and any interaction related to the member in compliance with healthcare regulations
Qualification
Required
Licensed master's in social work or licensed Registered Nurse (RN) with a minimum of a bachelor's degree
Clinicians must be clinically licensed in the State they are managing members or have compact licensure
Certified Case Management (CCM) certification or willing to obtain within 1 year of hire (company sponsored)
Active drivers license as this is NOT a remote role and must have reliable transportation to enable face to face visit to members in facilities
Minimum of 3-5 years in Case/Care Management preferred and/or 5+ years of direct patient care
Knowledge of value-based care, fee for service and Medicare Advantage/Dual (Medicare/Medicaid), NCQA, HEDIS and basic Utilization Management functions
Expertise in care coordination for geriatric and high-risk populations
Ability and experience utilizing a variety of applications and databases to fulfill care management requirements, documentation. Documentation integrity is taken quite seriously and will be audited on a frequent basis
Critical thinking is key. Act before reacting
BE PRESENT both physically and for our members. Listen with compassion and learn to 'walk in one's shoes'
Must have integrity, be honest and have a strong ethical compass
Nimble, establish boundaries and foster emotional intelligence
Strong planning and organizational and time management skills with the ability to work independently
Must be excited by the opportunity to work within an integrated delivery system
Strong communication skills and the ability to work effectively with people coming from diverse cultural and professional perspectives
Subject matter expert in care management
Excellent interpersonal, written, and organizational skills required
Preferred
Minimum of 3-5 years in Case/Care Management preferred and/or 5+ years of direct patient care
Company
CommuniCare Advantage
CommuniCare Advantage provides accessible and affordable health insurance for special needs populations as defined by CMS.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase