Community Based Care Manager - RN or SW - Nevada - R9650-1 Join to apply for the Community Based Care Manager - RN or SW - Nevada - R9650-1 role at CareSource .
Job Summary
The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports, and the population through culturally competent delivery of care and coordination of services and supports. Facilitates communication, coordinates care and service of the member through assessments, identification and planning, and assists the member in creation and evaluation of person-centered care plans to prioritize and address what matters most, 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, considering cultural, linguistic, social, and environmental factors that shape health and access to care.
Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member.
Engage with the member in various settings including hospital, provider office, community agency, member’s home, telephonic or electronic communication to establish effective, professional relationships.
Develop and update a person-centered individualized care plan (ICP) in collaboration with the ICT based on the member’s desires, needs, and preferences.
Identify and manage barriers to achieving care plan goals.
Identify and implement effective interventions based on clinical standards and best practices.
Assist the member in managing and improving their health, wellness, safety, and self-care through effective care coordination and case management.
Coordinate, communicate, and collaborate with the member and ICT to achieve goals and maximize outcomes.
Educate the member and natural supports about treatment options, community resources, insurance benefits, etc., to facilitate informed decisions.
Continuously assess and document the member’s response to and progress on the ICP.
Evaluate member satisfaction through open communication and monitoring concerns or issues.
Monitor and promote effective utilization of healthcare resources.
Verify eligibility, previous enrollment, demographics, and current health status of each member.
Oversee timely psychosocial and behavioral assessments and care planning.
Participate in provider meetings to inform them of Care Management services and benefits.
Assist with ICDS model of care orientation and training for facility and community providers.
Identify and address gaps in care and access.
Collaborate with healthcare professionals and community-based organizations for post-discharge planning and care transition.
Adjust the intensity of interventions based on guidelines, member preferences, and care plan progress.
Terminate care coordination services appropriately based on case closure guidelines.
Provide clinical oversight to unlicensed team members as appropriate.
Document activities and responses in a timely manner following standards and policies.
Seek continuous improvement in member experience and share insights with leadership.
Travel regularly to conduct member, provider, and community visits as needed.
Adhere to NCQA and CMSA standards.
Perform other duties as assigned.
Education and Experience
Nursing degree or Bachelor’s in a healthcare field or equivalent experience.
Licensure as RN, Clinical Counselor, or Social Worker required.
Advanced degree preferred.
Minimum of 3 years of experience in nursing, social work, counseling, or healthcare roles.
Medicaid and/or Medicare managed care experience preferred.
Competencies, Knowledge, and Skills
Understanding of quality metrics, disease management, medication adherence.
Proficiency in Microsoft Office Suite.
Effective communication skills across diverse groups.
Ability to multitask and work independently and in teams.
Knowledge of healthcare laws, regulations, and case management standards.
Strong advocacy, cultural sensitivity, research interpretation, and organizational skills.
Licensure and Certification
Current unrestricted clinical license (RN, Social Worker, or Clinical Counselor).
Case Management Certification highly preferred.
Valid driver’s license, vehicle, and insurance required.
Influenza vaccination required during flu season.
Working Conditions
Travel required; must reside in the assigned territory.
May travel over 50% of the time.
Flexible hours, including evenings/weekends as needed.
Compensation Range
$61,500 - $98,400, with bonus potential and comprehensive benefits.
Employment Type
Full-time, Mid-Senior level, in the Health Care Provider industry.
This job description is not all-inclusive. CareSource reserves the right to amend it at any time. CareSource is an Equal Opportunity Employer, committed to diversity and inclusion.