Community Based Care Manager – Hamilton County
Job Summary
The Community Based Care Manager collaborates with an inter‑disciplinary care team, providers, community and faith‑based organizations to improve quality and meet the needs of individuals. Responsibilities include facilitating communication, coordinating care and services, and assisting members in creating and evaluating person‑centered care plans. The role focuses on addressing behavioral, physical and social determinants of health to improve members’ lives.
Essential Functions
Engage members and their natural support systems through strength‑based assessments and trauma‑informed, motivational interviewing approaches.
Facilitate interdisciplinary care team (ICT) meetings and provide regular updates to team members.
Develop and regularly update a person‑centered individualized care plan (ICP) in collaboration with the ICT.
Identify and manage barriers to achieving care‑plan goals and implement effective interventions based on clinical standards.
Assist members in managing health, wellness, safety and self‑care through effective care coordination and case management.
Coordinate communication and collaboration with the member and ICT to achieve goals and maximize positive outcomes.
Educate members and natural supports about treatment options, community resources and insurance benefits.
Employ ongoing assessment and documentation to evaluate the member’s response and progress on the ICP.
Monitor member satisfaction through open communication and monitoring of concerns.
Verify member eligibility, demographics and current health status.
Complete psychosocial and behavioral assessments, gathering information from the member, family, provider and stakeholders.
Coordinate with community‑based organizations, state agencies and other service providers to avoid duplication of services.
Adjust programmatic intervention intensity based on guidelines and member preferences.
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.
Perform any other duties as requested.
Education and Experience
Nursing degree from an accredited program or Bachelor’s degree in a health‑care field, or equivalent years of relevant work experience.
Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker.
Advanced degree associated with clinical licensure is preferred.
A minimum of three years of experience in nursing or social work or counseling or health‑care professions (e.g., discharge planning, case management, care coordination and/or home/community health management).
Three years of Medicaid and/or Medicare managed care experience is preferred.
Competencies, Knowledge and Skills
Strong understanding of quality metrics, HEDIS, disease management, medication reconciliation and adherence.
Intermediate proficiency with Microsoft Office (Outlook, Word, Excel).
Effective communication with a diverse group of individuals.
Ability to multitask and work independently within a team environment.
Knowledge of local, state and federal healthcare laws and regulations.
Adherence to Case Management Society of America (CMSA) standards.
Strong advocate for members at all levels of care and sensitivity to all cultures and demographic diversity.
Strong organizational and time‑management skills.
Licensure and Certification
Current unrestricted clinical license in the state of practice as a Registered Nurse, Social Worker and/or Clinical Counselor.
Case Management Certification is highly preferred.
Valid driver’s license, vehicle and verifiable insurance.
Influenza vaccination required for this position.
CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions.
Working Conditions
Mobile position: regular travel to homes, offices and other public settings; exposure to weather conditions.
May be required to travel greater than 50% of the time.
Flexible hours, including possible evenings and/or weekends as needed.
Compensation
Salary range: $61,500.00 – $98,400.00. Additional bonus tied to company and individual performance. Total rewards package available.
CareSource is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment.