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Community Based Care Manager
Community Based Care ManagerMedasource • Cuyahoga County, OH, United States
Community Based Care Manager

Community Based Care Manager

Medasource • Cuyahoga County, OH, United States
12 days ago
Job type
  • Temporary
Job description

Title : Community Based Care Manager

Contract : 12 month contract

Location : Travel Onsite in Cleveland Area

Schedule : 8-5 EST

Start Date : ASAP

Essential Functions :

  • 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 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 case managers 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 case managers and other service providers to ensure coordination and avoid duplication of services
  • Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required on going 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 standards (CMSA standards below)
  • Perform any other job duties as requested

Education and Experience :

  • 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
  • Advanced degree associated with clinical licensure is preferred
  • 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
  • Three (3) years Medicaid and / or Medicare managed care experience is preferred
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    Care Manager • Cuyahoga County, OH, United States

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