Community Based Care Manager

🔥 13 hours ago

🎰 Nevada – Remote

🎰 Nevada – Remote

💵 $62.7k - $100.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👫 Community Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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 members of an inter-disciplinary care team, providers, community organizations, and faith-based organizations • Conduct strength-based, trauma-informed health and psychosocial assessments using a health equity lens • Facilitate regularly scheduled inter-disciplinary care team meetings • Engage members in hospitals, provider offices, community agencies, homes, and through telephonic or electronic communication • Develop and regularly 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 and care services to support member health, wellness, safety, adaptation, and self-care • Educate members and natural supports about treatment options, community resources, and insurance benefits • Document and evaluate member responses and progress on care plans • Monitor member satisfaction, healthcare resource utilization, clinical variance, and benefits management • Verify member eligibility, enrollment history, demographics, and current health status • Complete and oversee psychosocial and behavioral assessments and care planning • Meet with providers to explain Care Management services and member benefits • Provide ICDS model-of-care orientation and training to facility and community providers • Identify and address gaps in care and access • Coordinate post-discharge care and transitions with facility-based healthcare professionals • Coordinate with community organizations, state agencies, and other service providers • Adjust intervention intensity based on guidelines, member preferences, healthcare needs, and care-plan progress • Provide clinical oversight and direction to unlicensed team members • Document care coordination activities according to standards and CareSource policies • Identify process improvements and share repeatable improvements with leadership • Travel regularly for member, provider, and community-based visits • Adhere to NCQA and CMSA standards • Perform other duties as requested

🎯 Requirements

• Nursing degree from an accredited nursing program, Bachelor’s degree in a health care field, or equivalent years of relevant work experience is required • Current unrestricted clinical license in the state of practice as a Registered Nurse, Social Worker, or Clinical Counselor is required • Minimum of three (3) years of experience in nursing, social work, counseling, or a health care profession is required • Advanced degree associated with clinical licensure is preferred • Three (3) years of Medicaid and/or Medicare managed care experience is preferred • 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 CMSA standards for case management practice • Knowledge of community and state support resources • Critical listening, thinking, decision-making, problem-solving, organizational, and time-management skills • Must have a valid driver’s license, vehicle, and verifiable insurance • Successful driver’s license record check and verified insurance required • Annual influenza vaccination required during influenza season, with proof of vaccination • Must reside in the same assigned territory; exceptions may be considered due to business need • May be required to travel greater than 50% of the time • Flexible availability, including possible evenings and weekends

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Reasonable accommodations for qualified individuals • Annual influenza vaccination requirement covered as an employment health protection measure