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Job type full-time
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Full job description
Job summary:
The community based case manager – rn collaborates with members of an inter-disciplinary care team (ict) to meet the needs of the individual and the population and identifies problems or opportunities that would benefit from care coordination.
Essential functions:
Engage the member and complete a health and psychosocial assessment, taking into account the cultural and linguistic needs of each member
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 relationshipSettings for engagement include but are not limited to hospital, provider office, community agency, member’s home, telephonic or electronic communication
Develop an individualized care plan (icp) in collaboration with the ict, based on member’s 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/caregivers about treatment options, community resources, insurance benefits, etcSo 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
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 mycare or dsnp plan
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
Look for ways 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
Perform any other job duties as requested
Additional essential functions for mycare or dsnp case managers:
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
Education and experience:
Nursing degree from an accredited nursing program is required
Bachelors of science in nursing is preferred
Licensure as a registered nurse is required
A minimum of three (3) years of experience in nursing (i.eDischarge planning, case management, care coordination, and/or home/community health management experience) is required
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 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 members 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
Licensure and certification:
Current unrestricted clinical license in state of practice as a registered nurse is required
Case management certification is highly preferred
Must have valid driver’s license, vehicle and verifiable insuranceEmployment in this position is conditional pending successful clearance of a driver’s license record check and verified insuranceIf 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 checkResults 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, members, and the communities we serve from acquiring communicable diseases, full covid-19 and influenza vaccination is an essential requirement of this position.
Caresource requires annual proof of influenza vaccination for designated positions during influenza season (october 1 – march 31) as a condition of continued employmentEmployees hired during influenza season will have forty-five (45) days from their hire date to complete the required vaccination.
Caresource requires all employees 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 virusEmployees are required to disclose and provide proof of their vaccination status as a condition of continued employmentCandidates who accept an offer of employment must upload proof of vaccination prior to their start dateFailure 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.
Caresource adheres to all federal, state, and local regulationsCaresource 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 positionRequest for accommodations will be reviewed by the caresource health & wellness team.
Working conditions:
This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essentialWill 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
This job description is not all inclusiveCaresource reserves the right to amend this job description at any timeCaresource is an equal opportunity employer, including disability and veteran statusWe are committed to a diverse and inclusive work environment.
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Posted 17 days ago
