What are the responsibilities and job description for the Community Based Care Manager position at Professional Management Enterprises?
The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination of services and supports. Facilitates communication, coordinates care and service of the member through assessments, identification and planning, and assists the member in creation and evaluation of person-centered care plans to prioritize and address what matters most, behavioral, physical and social determinants of health needs with the aim to improve the of lives our members.
Full-Time 40 hrs
3 Month Assignment
MUST LIVE IN OHIO
Essential Functions:
* Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks
* 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 relationship. Settings for engagement include but are not limited to hospital, provider office, community agency, member's home, telephonic or electronic communication
* Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on member's desires, 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/ natural supports about treatment options, community resources, insurance benefits, etc. so 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
* 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
* Identify and address gaps in care and access
* Collaborate with facility-based healthcare professionals 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 organizations, state agencies and other service providers to ensure coordination and avoid duplication of services
* Adjust the intensity of programmatic interventions provided to member based on established guidelines and in accordance with the member's preferences, changes in special healthcare needs, and care plan progress
* Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required ongoing care coordination.
* 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
* Continuously assess for areas 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
* Adherence to NCQA and CMSA standards
* Perform any other job duties as requested
* Education and Experience:
* Nursing degree from an accredited nursing program or Bachelor's degree in a health care field or equivalent years of relevant work experience is required
* Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is required
* Advanced degree associated with clinical licensure is preferred
* A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required
* Three (3) years Medicaid and/or Medicare managed care experience is preferred
* Competencies, Knowledge and Skills:
* Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence
* 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 sensitivity 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
Education and Experience:
* Nursing degree from an accredited nursing program or Bachelor's degree in a health care field or equivalent years of relevant work experience is required
* Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is required
* Advanced degree associated with clinical licensure is preferred
* A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required
* Three (3) years Medicaid and/or Medicare managed care experience is preferred
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
Full-Time 40 hrs
3 Month Assignment
MUST LIVE IN OHIO
Essential Functions:
* Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks
* 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 relationship. Settings for engagement include but are not limited to hospital, provider office, community agency, member's home, telephonic or electronic communication
* Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on member's desires, 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/ natural supports about treatment options, community resources, insurance benefits, etc. so 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
* 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
* Identify and address gaps in care and access
* Collaborate with facility-based healthcare professionals 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 organizations, state agencies and other service providers to ensure coordination and avoid duplication of services
* Adjust the intensity of programmatic interventions provided to member based on established guidelines and in accordance with the member's preferences, changes in special healthcare needs, and care plan progress
* Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required ongoing care coordination.
* 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
* Continuously assess for areas 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
* Adherence to NCQA and CMSA standards
* Perform any other job duties as requested
* Education and Experience:
* Nursing degree from an accredited nursing program or Bachelor's degree in a health care field or equivalent years of relevant work experience is required
* Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is required
* Advanced degree associated with clinical licensure is preferred
* A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required
* Three (3) years Medicaid and/or Medicare managed care experience is preferred
* Competencies, Knowledge and Skills:
* Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence
* 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 sensitivity 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
Education and Experience:
* Nursing degree from an accredited nursing program or Bachelor's degree in a health care field or equivalent years of relevant work experience is required
* Licensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is required
* Advanced degree associated with clinical licensure is preferred
* A minimum of three (3) years of experience in nursing or social work or counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required
* Three (3) years Medicaid and/or Medicare managed care experience is preferred
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
