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CareSource

Member-first health plan: Marketplace, Medicare, Medicaid

Manager – Case Management RN

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeArkansas, USA

About the Job

Requirements

  • A bachelor's degree in Nursing, a healthcare field, business administration, or a related field, or equivalent years of relevant work experience, is required.
  • A minimum of five years of clinical experience is required.
  • Intermediate proficiency in Microsoft Outlook, Word, and Excel is required.
  • Ability to use a smartphone, iPad, or other mobile communication device to perform essential functions is required.
  • Ability to communicate effectively with a diverse group of individuals is required.
  • Ability to multitask and work independently within a team environment is required.
  • Ability to collaborate with and effectively lead team members to optimize member outcomes is required.
  • Familiarity with state and federal healthcare regulations and the healthcare environment is required.
  • Awareness of community and state support resources for the population served is required.
  • Critical listening, thinking, decision-making, and problem-solving skills are required.
  • Proper grammar usage, strong organizational and time-management skills, and proper phone etiquette are required.
  • Training and teaching skills, as well as management and supervisory skills, are required.
  • A current, unrestricted Ohio license as a Registered Nurse, Licensed Independent Social Worker, Psychologist, or Licensed Professional Clinical Counselor is required.
  • A driver’s license record check must be cleared successfully; unacceptable results result in withdrawal or termination of employment.
  • Annual influenza vaccination is required for designated positions during influenza season, with employees hired during that season required to complete it within 30 days of hire.
  • The employee must reside in the territory assigned, although exceptions may be considered based on business need.
  • A valid driver’s license, car, and insurance are necessary for work-related travel.
  • The employee must be able to travel as needed, potentially more than 50% of the time, and work flexible hours, including possible evenings or weekends.
  • The employee must be able to use general office equipment, including a telephone, photocopier, fax machine, and personal computer.

Responsibilities

  • Oversee Integrated Care Duals Product Teams as they coordinate care, services, and health benefits for selected member populations.
  • Monitor and promote safe, effective utilization of healthcare resources through clinical variance and benefits management.
  • Manage the performance of Integrated Care Management Liaisons and internal and external Care Management teams to support safe service delivery, quality outcomes, and compliance with state and accreditation requirements.
  • Assist with verifying member eligibility, prior enrollment history, demographics, and current health status as appropriate.
  • Audit and review documentation gathered by internal staff and external partners for thoroughness, accuracy, and care-management competency.
  • Contribute to ongoing review of member care plans by defining issues, goals, and interventions as appropriate.
  • Maintain member-to-case-manager caseload ratios at optimal levels.
  • Ensure teams monitor and evaluate care-plan effectiveness through ongoing contact with members, families, providers, and stakeholders.
  • Assist member liaisons in facilitating and coordinating services according to treatment plans developed with stakeholders.
  • Coordinate day-to-day Care Center operations and team activities with peer managers and the director, including staff orientation, scheduling, training, in-service education, quality and performance improvement, and regulatory and contractual compliance.
  • Oversee effective care planning and implementation to meet member needs.
  • Coordinate services with community partners to maximize appropriate community resources and support and ensure transitions between care settings.
  • Work with Incident Management staff to review and investigate member incidents and health or safety issues.
  • Work with Community Partners, Provider Relations, and Network Management staff to monitor quality issues involving network providers.
  • Monitor scheduling, work allocation, and productivity.
  • Monitor quality and conduct regularly scheduled one-on-one meetings with team members.
  • Work with corporate staff to follow up on and review member complaints and grievances.
  • Monitor and analyze Integrated Care Management data and reporting.
  • Ensure compliance with the Integrated Care product model of care.
  • Oversee or maintain accurate documentation of contacts, care treatment plans, case notes, referrals, and assessments in the Care Management electronic record in accordance with program protocols and guidelines.
  • Review and update Care Management policies and Standard Operating Procedures.
  • Participate in provider meetings to explain Care Management services and member benefits as needed.
  • Serve as an interdepartmental liaison and share information about issues related to the Care Management process.
  • Assist with educating members or caregivers about healthcare access and benefits, and provide health education and wellness materials as needed.
  • Precept or mentor new staff and provide ongoing training, mentoring, coaching, and disciplinary action as needed.
  • Participate in hiring Integrated Care Management personnel.
  • Provide guidance and instruction to Integrated Care Team Leads and other staff through formal and informal meetings.
  • Travel to member, provider, and community-based visits as needed to administer the program effectively.
  • Perform other job duties as requested.

Desired Qualifications

  • At least three years of Medicaid or Medicare managed-care or HCSB Waiver case-management experience is preferred.
  • Three years of experience as a case manager is preferred.
  • Two years of management experience is preferred.
  • Case Management certification is preferred.

About the Company

CareSource

Member-first health plan: Marketplace, Medicare, Medicaid

CareSource provides health coverage to more than 2 million members, offering Marketplace plans as well as Medicare and Medicaid products. Its core service is delivering health insurance and related care to individuals and communities through a member-first approach, aiming to improve health and well-being over time. The company operates with a focus on affordable, accessible coverage and care coordination across states, guided by its mission to place people over profits rather than simply selling plans. Key differentiators include a long history (30+ years), a national footprint with 4,500+ employees, and an emphasis on serving members’ needs and languages while promoting equal opportunity employment. The overarching goal is to help members live healthier lives by providing comprehensive coverage and support.

Company size
1,001-5,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Dayton, OH
Founded
1989

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