Mom & Baby Care Manager RN - Must reside in Nevada at CareSource

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 frameworksFacilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the memberEngage with the member to establish an effective, professional relationship via 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 on going 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 processAdherence 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 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 requiredMaternity/Mother and Baby care experience strongly preferredThree (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 adherence Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel Ability 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 Professional 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 preferredWorking Conditions:Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computerFlexible hours, including possible evenings and/or weekends as needed to serve the needs of our membersCompensation Range:$61,500.00 - $98,400.00 CareSource 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 latitude required for the role, and other external and internal data when establishing a salary level. In addition to base 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:SalaryCompetencies:- Fostering a Collaborative Workplace Culture- Cultivate Partnerships- Develop Self and Others- Drive Execution- Influence Others- Pursue Personal Excellence- Understand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JS1