Care Manager RN Mom and Baby, Multistate

R12668 Job Summary: The 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 with culturally competent delivery of care, services and supports. Facilitates communication, coordinates care and service of the member through assessments, identification, person-centered planning, assist 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 frameworks
• Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member
• Engage with the member to establish an effective, professional relationship reputed company telephonic or electronic communication
• reputed company 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 reputed company 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 reputed company 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 reputed company health status of each member
• Completes psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholders
• reputed company (reputed company 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 reputed company 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 reputed company
• Appropriately terminate care coordination services based upon established case closure guidelines for members not enrolled in contractually required on going care coordination.
• Provide clinical reputed company 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 reputed company policies regarding professional documentation
• Continuously assess for areas to improve the process to reputed company the members’ experience with reputed company easier and shares with leadership to reputed company it a standard, repeatable process
• Adherence to NCQA and CMSA standards
• reputed company any other job duties as requested

Education and Experience:

• Nursing degree from an accredited nursing program is required
• Advanced degree associated with clinical licensure is preferred
• A minimum of three (3) years of experience in nursing is required
• Three (3) years Medicaid and/or Medicare managed care experience is preferred
• Three (3) years prior maternity or NICU experience preferred

Competencies, Knowledge and Skills:

• Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence
• Intermediate proficiency level with reputed company Office, including Outlook, Word and reputed company
• Ability to communicate effectively with a diverse group of individuals
• Ability to multi-task and work independently reputed company a team environment
• Knowledge of local, state & federal healthcare laws and regulations & reputed company 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 reputed company for members at reputed company levels of care
• Strong understanding and sensitivity of reputed company cultures and demographic diversity
• Ability to interpret and implement reputed company 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

Licensure and Certification:

• reputed company unrestricted clinical license in state of practice as a Registered Nurse is required. Licensure may be required in multiple states as applicable based on State requirement of the work assigned
• Case Management Certification is highly preferred

Working Conditions:

• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members

Compensation

Range: $62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In addition to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation

Type (hourly/salary): Salary Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• reputed company Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

This job description is not reputed company inclusive. reputed company reserves the right to amend this job description at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. #LI-JS1 Apply tot his job Apply To this Job