Care Manager, Mom and Baby

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $62.7k - $100.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Collaborate with interdisciplinary care teams, providers, community organizations, and faith-based organizations • Conduct health and psychosocial assessments using strength-based, trauma-informed, motivational interviewing, and health-equity approaches • Facilitate interdisciplinary care team meetings • Establish professional member relationships through telephonic or electronic communication • Develop and update individualized, person-centered care plans • Identify and manage barriers to care-plan goals • Implement interventions based on clinical standards and best practices • Coordinate case management, care transitions, and community services • Educate members and natural supports about treatment options, community resources, and insurance benefits • Document assessments, care coordination activities, and member responses • Monitor healthcare resource utilization, clinical variance, and benefits management • Verify member eligibility, enrollment history, demographics, and health status • Oversee psychosocial and behavioral assessments and care-plan execution • Inform providers about Care Management services and benefits • Support ICDS model-of-care orientation and training for facility and community providers • Identify and address gaps in care and access • Coordinate post-discharge care and transitions to appropriate levels of care • Adjust intervention intensity according to guidelines, member preferences, healthcare needs, and care-plan progress • Provide clinical oversight and direction to unlicensed team members • Assess process improvements and share repeatable improvements with leadership • Adhere to NCQA and CMSA standards and perform other related duties

🎯 Requirements

• Associate of Science (A.S.) degree from an accredited nursing program required, or Bachelor's degree in a healthcare field required • Equivalent years of relevant work experience may be accepted in lieu of required education • Three (3) years of experience in nursing, social work, counseling, or a healthcare profession required • Current unrestricted clinical license in state of practice as a Registered Nurse, Social Worker, or Professional Clinical Counselor required • Licensure may be required in multiple states as applicable based on work assigned • Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation, and adherence • Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel • Knowledge of local, state, and federal healthcare laws and regulations and company case management policies • Knowledge of and adherence to Case Management Society of America (CMSA) standards • Critical listening, thinking, decision-making, problem-solving, organizational, and time-management skills • Ability to communicate effectively with diverse individuals • Ability to multitask and work independently within a team environment • Awareness of community and state support resources • Master's or Bachelor's degree associated with clinical licensure preferred • Three (3) years of Medicaid and/or Medicare managed care experience preferred • Three (3) years of maternity, NICU, or postpartum experience preferred • Case Management Certification highly preferred

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Flexible hours, including possible evenings and/or weekends as needed • Remote work arrangement • Travel is not typically required

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