Community Based Care Manager

Columbus, a CareSource Company

Job Summary :

The Community Based Care Manager is responsible for assessment and care management of long-term care clients of any age enrolled on waiver programs and functions in a collaborative team role as an integral member of the interdisciplinary care team (ICT).

Essential Functions :

• Acts as a liaison and fosters relationships with waiver providers, state agencies, waiver participants and other community agencies to support individuals with disabilities.
• Always maintains the confidentiality and integrity of the company, complying with HIPAA, and Columbus Organization / CareSource Policies.
• In collaboration with the interdisciplinary care team, develops, updates, and reviews the Person-Centered Individualized Support Plan (PCSP) using person-centered planning processes based on individual’s needs and preferences to achieve optional individual outcomes.
• Engages the individual to complete program specific Level of Care determination through initial, annual, and event-based assessments evaluating program eligibility and needs, considering the cultural and linguistic needs of each individual.
• Monitors service delivery and utilization (via telephone and video calls, home visits, face to face contacts and team meetings) to ensure services being delivered are in accordance with the PCSP.
• Facilitates coordination, communication, and collaboration with the individuals of the interdisciplinary care team in order to achieve goals and maximize positive individual outcomes
• Ensures the health and safety of the individuals as well as monitors individual satisfaction and service outcomes.
• Identifies and implements effective interventions based on clinical standards and best practices.
• Assists with empowering the individual to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management.
• Educates the individual / caregivers about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made.
• Documents care coordination activities and individual response in a timely manner according to standards of practice and Columbus Organization / CareSource policies regarding professional documentation
• Documents current list of medications and assists with medication adherence (linkage / resources).
• Regularly verify Medicaid eligibility.
• Develops initial, annual and updates Cost Comparison Budgets using the state approved process.
• Adheres to the reporting requirements for incidents and prevention from harm planning by completing, submitting, and following up on incident reports in a timely fashion using the state approved process.
• Maintains files in accordance with state standards.
• Disseminates information including all Notices of Action (NOA) and forms to the individual and Individual Support Team (IST) as required by state office.
• Cultivates and strengthens informal and natural supports for each individual and identifies resources and negotiates the best solutions to meet identified needs.
• Collaborates with facility-based care 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.
• Coordinates with community-based care managers and other service providers to ensure coordination and avoid duplication of services.
• Completes community outreach per the Case Management Outreach Plan on an ongoing basis with individuals, families, community stakeholders, and provider / state agencies to develop strategies that positively impact the individual experience and increase the awareness of the benefits of using The Columbus Organization / CareSource partnership.

Shares with Senior Leadership for possible generalization across the program.

On-call responsibilities as assigned.

Education and Experience :

• Bachelor’s or Associates degree in a health care field is required
• Current and unrestricted clinical license in the State of Ohio as a licensed social worker (LSW, LISW) is required
• One (1) year HCBS paid experience
• Three (3) years or more Medicaid and / or Medicare managed care experience is preferred

Competencies, Knowledge and Skills :

• Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel
• Ability to operate a computer and perform basic Windows functions for entering, updating, and maintaining data
• Elevated level of initiative, self-direction and accountability for actions required
• Performance of principle duties and responsibilities require the ability to travel if needed
• Must have and maintain a valid state driver's license, maintain automobile insurance coverage, and have access to an automobile during working hours
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Knowledge of planning principles and report preparation
• Skill in interpreting, policies, and procedures
• Skill in analyzing situations, evaluate information and recommend course of action
• Skill in maintaining effective working relationships with fellow employees and outside agencies
• Ability to evaluate issues, explain rules and regulations
• Ability to write reports and correspondence
• Ability to effectively present information and respond to questions from groups of managers and associates
• Ability to communicate effectively with a diverse group of individuals
• Ability to multi-task and work independently within a team environment
• Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
• Adhere to 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 individuals at all levels of care
• Strong understanding and respect of 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
• Ability to maintain confidentiality
• Ability to use and transport a laptop computer and case, therefore must be able to lift / carry a minimum of 20 pounds

Licensure and Certification :

• Current and unrestricted clinical license in the State of Ohio as Registered Nurse (RN) or licensed social worker (LSW, LISW) is required
• Case Management Certification is highly preferred
• Must have valid driver’s license, vehicle, and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check and verified insurance.

If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated.

• Employment in this position is conditional pending successful clearance of a criminal background check. Results of the criminal background check may necessitate an offer of employment being withdrawn or, if employee has started in position, termination of employment.
• To help protect our employees, individuals, and the communities we serve from acquiring communicable diseases, full COVID-19 and Influenza vaccination is preferred.
• When required by a State Office, Columbus case management employees will be required to be fully vaccinated (two weeks removed from completion of a two-dose mRNA series or two weeks removed from a one dose vaccine) against the COVID-19 virus.

Employees are required to disclose and provide proof of their vaccination status as a condition of continued employment.

Candidates who accept an offer of employment must upload proof of vaccination prior to their start date. Failure to meet the vaccination requirement, including providing proof of vaccination prior to the start date, may result in rescission of an employment offer or termination of employment.

The Columbus Organization / CareSource adheres to all federal, state, and local regulations. The Columbus Organization / CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position.

Request for accommodations will be reviewed by the Columbus HR Department.

Working Conditions :

This is a mobile position, meaning that regular travel to different work locations, including homes, offices, or other public settings, is essential.

Will be exposed to weather conditions typical of the location and may be required to stand and / or sit for long periods of time.

• Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need
• May be required to travel greater than 50% of time to perform work duties.
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
• Flexible hours, including possible evenings and / or weekends as needed to serve the needs of our members

COORD