Community Based Care Manager

This is a fully remote position, open to applicants in Nevada.

📋 Description

• Collaborate with a diverse care team, healthcare providers, community organizations, and faith-based entities.

• Conduct assessments that are strength-based and trauma-informed, utilizing a health equity perspective.

• Facilitate regular meetings for the interdisciplinary care team.

• Engage with members in various settings including hospitals, provider offices, community agencies, homes, and via telephonic or electronic means.

• Create and consistently update personalized, person-centered care plans.

• Identify and address obstacles to achieving care plan objectives.

• Implement interventions aligned with clinical standards and best practices.

• Coordinate case management and care services to enhance member health, wellness, safety, adaptation, and self-care.

• Educate members and their natural supports regarding treatment options, community resources, and insurance benefits.

• Document and assess member responses and progress regarding care plans.

• Monitor member satisfaction, healthcare resource usage, clinical variances, and benefits management.

• Verify member eligibility, enrollment history, demographics, and current health status.

• Complete and oversee psychosocial and behavioral evaluations and care planning.

• Meet with providers to clarify Care Management services and member benefits.

• Provide orientation and training on the ICDS model of care to facility and community providers.

• Identify and mitigate gaps in care and access.

• Coordinate post-discharge care and transitions with healthcare professionals in facilities.

• Collaborate with community organizations, state agencies, and other service providers.

• Adjust intervention intensity in accordance with guidelines, member preferences, healthcare needs, and progress on care plans.

• Offer clinical oversight and direction to unlicensed team members.

• Document care coordination activities in compliance with standards and CareSource policies.

• Identify opportunities for process improvements and communicate sustainable enhancements to leadership.

• Travel regularly for visits to members, providers, and community engagements.

• Adhere to NCQA and CMSA standards.

• Perform additional duties as assigned.

⛳️ Requirements

• A nursing degree from an accredited program, a Bachelor's degree in a healthcare field, or equivalent relevant work experience is required.

• A current, unrestricted clinical license as a Registered Nurse, Social Worker, or Clinical Counselor in the state of practice is mandatory.

• A minimum of three (3) years of experience in nursing, social work, counseling, or a healthcare profession is essential.

• An advanced degree related to clinical licensure is preferred.

• Preferred experience includes three (3) years in Medicaid and/or Medicare managed care.

• A solid understanding of Quality, HEDIS, disease management, supportive medication reconciliation, and adherence.

• Intermediate proficiency in Microsoft Office applications, including Outlook, Word, and Excel.

• Familiarity with local, state, and federal healthcare laws and regulations, as well as company case management policies.

• Knowledge of CMSA standards for case management practices.

• Awareness of community and state support resources.

• Strong critical listening, thinking, decision-making, problem-solving, organizational, and time-management abilities.

• A valid driver’s license, vehicle, and verifiable insurance are required.

• A successful driver’s license record check and verified insurance are necessary.

• Annual influenza vaccination is required during flu season, with proof of vaccination.

• Must reside within the designated territory; exceptions may be made based on business needs.

• May be required to travel more than 50% of the time.

• Flexible availability, including the potential for evening and weekend work.

🏝️ Benefits

• Potential for bonuses linked to both company and individual performance.

• A comprehensive total rewards package.

• Reasonable accommodations available for qualified individuals.

• Annual influenza vaccination requirement covered as a health protection measure for employment.