Care Manager - Medasource : Job Details

Essential Functions:

• Make Level of Care determinations to determine member program eligibility as part of initial, annual and event-based assessments

• Engage the member to complete program specific initial, annual and event-based assessments evaluating program eligibility and needs, taking into account the cultural and linguistic needs of each member

• Assess for service needs, authorize services and arrange for service delivery

• Development and implementation of comprehensive person-centered care plan/service plan, in collaboration with the interdisciplinary care team, based on member's needs and preferences to achieve optional member outcomes

• Employ ongoing assessment and documentation to evaluate the member's response to and progress on the PCSP

• Facilitate and coordinate services based upon the care treatment plan developed in collaboration with all stakeholders

• Evaluation of care/service plan on an ongoing basis through member, family, provider and stakeholder contact

• 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

• Educate the member/caregivers about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made

• 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

• Document current list of medications and assist with medication adherence (linkage/resources)

• Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation

• Facilitate interdisciplinary care team meetings to meet the needs of the member

• Facilitate coordination, communication and collaboration with the members of the interdisciplinary care team in order to achieve goals and maximize positive member outcomes

• 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

• Adhere to the reporting requirements for incidents and prevention from harm planning

• 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

• Actively participate in team meetings

• Regular travel to conduct member, provider and community-based visits as needed to ensure effective administration of the program

• Regularly verify Medicaid eligibility

• On-call responsibilities as assigned

• Perform any other job duties as requested

Education and Experience:

• Nursing degree from an accredited nursing program or Bachelor's degree in health care field or equivalent years of relevant work experience is required

• Minimum of 1 year paid clinical experience in home and community-based services 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

• 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

• Must have a car available during working hours, as well as the ability to legally drive a car

Licensure and Certification:

• Current and unrestricted license as a Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW) in the State of Ohio 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, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a 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 employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.

• CareSource adheres to all federal, state, and local regulations. 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 completed through an interactive review process.

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