Apply on Employer Site

CareSource · 4 months ago

Community Based Care Coordinator (RN/Social Worker/Clinical Counselor) – Duals Integrated Care - Ohio Mobile

Ohio Mobile

Full-time

Hybrid

Mid Level

$62K/yr - $98K/yr

CareSource is a healthcare organization focused on improving health outcomes for individuals with complex health needs. The Community Based Care Coordinator, Duals Integrated Care is responsible for managing care for dual-eligible beneficiaries, integrating health services and community resources to enhance their quality of life.

Health CareMedicalNon Profit

Comp. & Benefits

Responsibilities

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

Perform any other job duties as requested

Qualification

Clinical licenseCare coordinationMedicaid/Medicare knowledgeCase Management CertificationMicrosoft Office proficiencyCultural sensitivityInterpersonal skillsProblem-solving skills

Required

Nursing degree from an accredited nursing program or bachelor's degree in a health care field or equivalent years of relevant work experience is required

Previous 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 required

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 assigned

Must 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

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