Community Based Care Manager4

HAP CareSource is a joint venture between Health Alliance Plan (HAP) a Michigan-based health plan that provides health coverage to individuals and companies of all sizes, and CareSource a nationally recognized managed care organization with more than 2 million members. HAP CareSource extends and enhances the mission-based legacies of two trusted, midwestern nonprofit organizations - offering comprehensive health coverage, access to physicians and quality care with compassion. The joint venture enables HAP CareSource to provide more Michiganders access to award-winning products, services and an expanded provider network and to expand services to Medicaid-eligible individuals in the Lower Peninsula.

Job Summary:

The Community Based Care Coordinator, Duals Integrated Care is responsible for managing and coordinating care for dual-eligible beneficiaries, those who qualify for both Medicare and Medicaid. This position focuses on integrating health services and community resources to improve health outcomes and enhance the quality of life for individuals with complex health needs.

Essential Functions:

Engage with the member in a variety of community-based settings to establish an effective, care coordination relationship, while considering the cultural and linguistic needs of each member.

Function as a liaison between healthcare providers, community resources, and dual-eligible beneficiaries to ensure seamless communication and care transitions.

Conduct comprehensive assessments to identify the physical, mental, and socials needs of dual-eligible individuals.

Develop and implement individualized care plans based on unique needs of each member, considering their medical, social, and behavioral health requirements.

Lead and collaborate with interdisciplinary care team (ICT) to create holistic care plans that address medical and non-medical needs.

Assist members in accessing community resources, including housing, transportation, food assistance, and social services.

Educate members about their benefits and available services under both Medicare and Medicaid.

Provide education to members and their families about managing chronic conditions, medication adherence, and preventive care.

Promote health lifestyle choices and self-management strategies.

Regularly monitor member's health status and care plan adherence, adjusting, as necessary.

Follow up with members after hospitalizations or significant health events to ensure continuity of care and prevent readmissions.

Work closely with primary care physicians, specialists, and other healthcare providers to coordinate care and share relevant information.

Coordinate with community-based organizations, other stakeholders/entities, state agencies, and other service providers to ensure coordination and avoid duplication of services.

Participate in care team meetings to discuss member progress and address barriers to care.

Maintain accurate and up-to-date records of members interactions, care plans, and outcomes.

Collect and analyze data to evaluate the effectiveness of care coordination efforts and identify areas of improvement.

Advocate for the needs and preferences of dual-eligible beneficiaries within the healthcare system.

Empower members to take an active role in their healthcare decisions.

Evaluate member satisfaction through open communication and monitoring of concerns or issues.

Regular travel to conduct member, provider and community-based visits as needed and per the regulatory requirements of the program.

Report abuse, neglect, or exploitation of older adults as a mandated reporter as required by State law.

On-call responsibilities as assigned.

Adherence to NCQA and CMSA standards.

Performs any other job related duties as requested.

Education and Experience:

Nursing degree from an accredited nursing program required orBachelor's degree in a health care field requiredEquivalent years of relevant work experience may be accepted in lieu of required educationPrevious experience in nursing, social work, counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management) experience requiredPrior experience in care coordination, case management, or working with dual-eligible populations preferredMedicaid and/or Medicare managed care experience preferred

Competencies, Knowledge and Skills:

Intermediate proficiency level with Microsoft Office, including Outlook, Word and ExcelUnderstanding of Medicare and Medicaid programs, as well community resources and services available to dual-eligible beneficiariesStrong interpersonal and communication skills to effectively engage with members, families, and healthcare providersAbility to manage multiple cases and priorities while maintaining attention to detailAdhere to code of ethics that aligns with professional practiceAwareness of and sensitivity to the diverse backgrounds and needs of the populations servedDecision making and problem-solving skills

Licensure and Certification:

Current, unrestricted clinical license in state of practice as a Registered Nurse, Social Worker or Clinical Counselor requiredLicensure 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. If the driver's license record results are... For full info follow application link. CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.