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 individual and population needs through culturally competent delivery of care and coordination of services and supports. The role facilitates communication, coordinates care and service of the member through assessments, identification and planning, and assists the member in the creation and evaluation of person‑centered care plans to address behavioral, physical and social determinants of health needs with the aim to improve the lives of our members.
Essential Functions
Engage the member and their natural support system through strength‑based assessments and a trauma‑informed care approach using motivational interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member.
Facilitate regularly scheduled inter‑disciplinary care team meetings to meet the member’s needs.
Engage with the member in a variety of settings (hospital, provider office, community agency, member’s home, telephonic or electronic communication) to establish an effective, professional relationship.
Develop and regularly update a person‑centered individualized care plan (ICP) with the ICT based on the 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 health, wellness, safety, adaptation and self‑care through effective care coordination and case management.
Facilitate coordination, communication and collaboration with the member and the ICT to achieve goals and maximize positive outcomes.
Educate the member and natural supports about treatment options, community resources and insurance benefits 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.
Monitor and promote effective utilization of healthcare resources through clinical variance and benefits management.
Verify eligibility, previous enrollment history, demographics and current health status of each member.
Complete psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholders.
Oversee 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.
Assist 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 based on established guidelines and the member’s preferences 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 member’s experience with CareSource easier and share improvements with leadership.
Regularly travel to conduct member, provider and community‑based visits as needed.
Adhere to NCQA and CMSA standards.
Perform any other job duties as requested.
Education & Experience
Nursing degree from an accredited nursing program or bachelor’s degree in a healthcare field or equivalent years of relevant work experience required.
Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker required.
Advanced degree associated with clinical licensure preferred.
Minimum of three (3) years of experience in nursing, social work or counseling or healthcare profession (e.g., discharge planning, case management, care coordination, and/or home/community health management) required.
Three (3) years of Medicaid and/or Medicare managed care experience preferred.
Competencies, Knowledge & Skills
Strong understanding of quality, HEDIS, disease management, medication reconciliation and adherence.
Intermediate proficiency in 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 & federal healthcare laws, regulations and company policies regarding case management practices.
Adherence to a code of ethics that aligns with professional practice.
Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice.
Strong advocate for members at all levels of care.
Strong understanding and sensitivity to all cultures and demographic diversity.
Ability to interpret and implement current research findings.
Awareness of community & state support resources.
Critical listening and thinking skills.
Decision making and problem‑solving skills.
Strong organizational and time‑management skills.
Licensure & Certification
Current unrestricted clinical license in the applicable state(s) as a Registered Nurse, Social Worker or Clinical Counselor required; licensure may be required in multiple states.
Case Management Certification highly preferred.
Valid driver’s license, vehicle and verifiable insurance required; employment is contingent upon successful clearance of a driver’s license record check.
Annual influenza vaccination required for designated positions during the influenza season (October 1 – March 31).
Reasonable accommodations provided to qualified individuals with disabilities, medical conditions or religious beliefs.
Working Conditions
Mobile position; regular travel to homes, offices or other public settings essential.
Exposure to weather conditions typical of the location; may be required to stand and/or sit for long periods.
Must reside in the assigned territory; exceptions considered for business need.
Travel greater than 50% of the time may be required.
Use of general office equipment (telephone, photocopier, fax machine, personal computer) required.
Flexible hours, including possible evenings and/or weekends as needed.
Compensation Range
$61,500.00 – $98,400.00. CareSource considers education, training, and experience when establishing a salary level. In addition to base compensation, employees may qualify for a performance‑based bonus. CareSource offers a comprehensive total rewards package.
Senior Level Information
Mid‑Senior level; Full‑time; Health Care Provider.
Equal Opportunity Employer
CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.