Community Based Care Manager

Community Based Care ManagerTrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the state and supported by CareSource's national leadership in quality and operational excellence. TrueCare offers locally based provider services through provider engagement representatives and customer care. Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care. By doing so, TrueCare will change the way health care is delivered in Mississippi.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.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 frameworksFacilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the memberEngage 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 communicationDevelop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT, based on member's desires, needs and preferencesIdentify and manage barriers to achievement of care plan goalsIdentify and implement effective interventions based on clinical standards and best practicesAssist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case managementFacilitate coordination, communication and collaboration with the member the ICT in order to achieve goals and maximize positive member outcomesEducate the member/ natural supports about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be madeEmploy ongoing assessment and documentation to evaluate the member's response to and progress on the ICPEvaluate member satisfaction through open communication and monitoring of concerns or issuesMonitors and promotes effective utilization of healthcare resources through clinical variance and benefits managementVerify eligibility, previous enrollment history, demographics and current health status of each memberCompletes psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholdersOversee (point of contact) timely psychosocial and behavioral assessments and the care planning and execution of meeting member needsParticipate in meetings with providers to inform them of Care Management services and benefits available to membersAssists with ICDS model of care orientation and training of both facility and community providersIdentify and address gaps in care and accessCollaborate 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 mannerCoordinate with community-based organizations, state agencies and other service providers to ensure coordination and avoid duplication of servicesAdjust 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 progressAppropriately 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 appropriateDocument care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentationContinuously 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 processRegular travel to conduct member, provider and community-based visits as needed to ensure effective administration of the programAdherence to NCQA and CMSA standardsPerform any other job duties as requestedEducation 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 requiredLicensure as a Registered Nurse, Professional Clinical Counselor or Social Worker is requiredAdvanced degree associated with clinical licensure is preferredA 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 requiredThree (3) years Medicaid and/or Medicare managed care experience is preferredCompetencies, Knowledge and Skills:Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherenceIntermediate proficiency level with Microsoft Office, including Outlook, Word and ExcelAbility to communicate effectively with a diverse group of individualsAbility to multi-task and work independently within a team environmentKnowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practicesAdhere to code of ethics that aligns with professional practiceKnowledge of and adherence to Case Management Society of America (CMSA) standards for case management practiceStrong advocate for members at all levels of careStrong understanding and sensitivity of all cultures and demographic diversityAbility to interpret and implement current research findingsAwareness of community & state support resourcesCritical listening and thinking skillsDecision making and problem-solving skillsStrong organizational and time management skillsLicensure and Certification:Current unrestricted clinical license in state of practice as a Registered Nurse, Social Worker or Clinical Counselor is required. Licensure may be required in multiple states as applicable based on State requirement of the work assignedCase Management Certification is highly preferredMust 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.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 needMay 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