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CareSource

Member-first health plan: Marketplace, Medicare, Medicaid

Community Based Care Manager RN

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

About the Job

Requirements

  • A nursing degree from an accredited nursing program or a bachelor's degree is required.
  • A current unrestricted clinical license in the state of practice as a Registered Nurse, Social Worker, or Clinical Counselor is required; licensure in multiple states may be required depending on the assigned work and state requirements.
  • At least three years of experience in nursing, social work, counseling, or another healthcare profession is required, including experience such as discharge planning, case management, care coordination, or home/community health management.
  • Must have a valid driver's license, a vehicle, and verifiable insurance; employment is conditional on successful driver's-license-record clearance and verified insurance.
  • Annual proof of influenza vaccination is required for designated positions during influenza season (October 1 through March 31); employees hired during that season have 30 days from hire to complete the vaccination and verify immunization.
  • Must reside in the assigned territory, although exceptions may be considered based on business need.
  • Must be able to travel regularly to member, provider, and community locations and may be required to travel more than 50% of the time.
  • Must be able to work flexible hours, including possible evenings and weekends, as needed to serve members.
  • Must use general office equipment, including a telephone, photocopier, fax machine, and personal computer.
  • Strong understanding of Quality, HEDIS, disease management, medication reconciliation, and medication adherence.
  • Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel.
  • Knowledge of local, state, and federal healthcare laws and regulations, and company policies regarding case management practices.
  • Must adhere to a code of ethics aligned with professional practice and to Case Management Society of America standards for case management practice.
  • Ability to interpret and implement current research findings and awareness of community and state support resources.
  • Critical listening and thinking, decision-making, problem-solving, organizational, and time-management skills.
  • Ability to communicate effectively with diverse individuals and to multitask and work independently within a team environment.
  • Strong understanding of and sensitivity to cultures and demographic diversity; ability to advocate for members at all levels of care.

Responsibilities

  • Engage members and their natural support systems through strength-based assessments and a trauma-informed care approach, using motivational interviewing to complete health and psychosocial assessments through a health-equity lens. Identify cultural, linguistic, social, and environmental factors that shape health, contribute to disparities, and affect access to public and community health frameworks.
  • Facilitate regularly scheduled interdisciplinary care team meetings to meet member needs.
  • Engage members in settings including hospitals, provider offices, community agencies, members' homes, and through telephone or electronic communication to establish effective professional relationships.
  • Develop and regularly update an individualized, person-centered care plan in collaboration with the interdisciplinary care team and based on members' desires, needs, and preferences.
  • Identify and manage barriers to achieving care-plan goals.
  • Identify and implement effective interventions based on clinical standards and best practices.
  • Help members manage and improve their health, wellness, safety, adaptation, and self-care through care coordination and case management.
  • Facilitate coordination, communication, and collaboration with members and the interdisciplinary care team to achieve goals and maximize positive outcomes.
  • Educate members and their natural supports about treatment options, community resources, and insurance benefits to support timely, informed decisions.
  • Conduct ongoing assessments and document members' responses and progress on individualized care plans.
  • Evaluate member satisfaction through open communication and monitoring concerns or issues.
  • Monitor and promote effective utilization of healthcare resources through clinical variance and benefits management.
  • Verify each member's eligibility, previous enrollment history, demographics, and current health status.
  • Complete psychosocial and behavioral assessments by gathering information from members, families, providers, and other stakeholders.
  • Serve as the point of contact to oversee timely psychosocial and behavioral assessments, care planning, and execution of plans to meet member needs.
  • Meet with providers to inform them about care management services and benefits available to members.
  • Assist with orientation and training on the ICDS model of care for facility and community providers.
  • Identify and address gaps in care and access.
  • Collaborate with facility-based healthcare professionals and providers to plan post-discharge care or facilitate timely, cost-effective transitions to an appropriate level of care.
  • Coordinate with community-based organizations, state agencies, and other service providers to coordinate services and avoid duplication.
  • Adjust the intensity of programmatic interventions based on established guidelines, member preferences, changes in special healthcare needs, and care-plan progress.
  • Terminate care coordination services according to 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 responses promptly, in accordance with standards of practice and CareSource professional-documentation policies.
  • Continuously identify process improvements that make members' experiences easier and share them with leadership to establish standard, repeatable processes.
  • Perform other job duties as requested.

Desired Qualifications

  • An advanced degree associated with clinical licensure is preferred.
  • Three years of Medicaid and/or Medicare managed-care experience is preferred.
  • Case Management Certification is highly 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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