Mom and Baby Care Manager - RN - Must reside in Nevada

$62,700 - $100,400 / year

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 via telephonic or electronic communication
Develop 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 achieve 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 progress 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 current health status of each member
Completes psychosocial and behavioral assessments by gathering information from the member, family, provider and other stakeholders
Oversee (point 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 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 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 progress
Appropriately 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 appropriate
Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation
Continuously 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 process
Adherence to NCQA and CMSA standards
Perform any other job duties as requested

Education 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 required
Advanced degree associated with clinical licensure is preferred
A 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 required
Three (3) years Medicaid and/or Medicare managed care experience is preferred

Competencies, 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 individuals
Ability to multi-task and work independently within a team environment
Knowledge of local, state & federal healthcare laws and regulations & all 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 advocate for members at all levels of care
Strong understanding and sensitivity of all cultures and demographic diversity
Ability to interpret and implement current 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:

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 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 - $100,400.00

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 (hourly/salary):

Salary

Organization Level Competencies

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

This 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.

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Promotes a culture of safety through identifying threats to patient safety and intervening to prevent patient harm. Reports patient safety events and near misses in a timely manner. Seeks to identify potential safety issues and assists in the implementation of corrective actions. Applies ethical decision making, demonstrates respect and understanding for peers, and other clinical disciplines. Participates as an effective member of the patient care team to formulate an integrated, unbiased, individualized approach to care. Participates in quality/process improvement initiatives to improve the functions of the department and the patient care experience. Participates in professional activities which contribute to personal professional development and the development of others. Seeks opportunities to be taught, coached, and mentored. Attends required meetings/educational programs and completes annual competencies in a timely manner. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards. Licensure, Registration, and/or Certification Required: Registered Nurse license issued by the state in which the team member practices, and Basic Life Support (BLS) for Healthcare Providers certification issued by the American Heart Association (AHA). Education Required: Completion of an accredited or approved program in Nursing. Experience Required: Typically requires 1 year of experience in clinical nursing. Knowledge, Skills & Abilities Required: Demonstrates progression to provide holistic patient care and the ability to view clinical situations from a patient and family focus. Demonstrates progression to recognize situational changes that require unplanned or unanticipated interventions, and responds to situations with confidence, timeliness and flexibility. Proficient computer skills, use of electronic mail and electronic medical records systems. Excellent communication (written and verbal), listening and interpersonal skills. Demonstrates human relation skills with the ability to develop rapport and maintain positive, professional relationships with a variety of patients, team members and physicians. Ability to take initiative and work collaboratively with others. Demonstrated ability to effectively make critical, independent decisions. Excellent organization, prioritization and problem-solving skills. Demonstrates time management skills with an ability to multi-task and prioritize in an environment with frequent interruptions. Demonstrates coordination, collaboration, delegation and team building skills. Certification Addendum: Team members will maintain annual educational requirements for hospital based certifications (e.g. DNV, CARF or others) Physical Requirements and Working Conditions: Must be able to sit, stand, walk, lift, squat, bend, reach above shoulders, and twist frequently throughout the workday. Must be able to: lift up to 50 lbs. from floor to waist. lift up to 20 lbs. over the head. carry up to 40 lbs. a reasonable distance. Must be able to: push/pull with 30 lbs. of force. perform a sliding transfer of 150 lbs. with a second person present. Position requires use of foot pedals on carts or machines. May be exposed to chemical and hazardous waste as well as blood and body fluids and communicable disease. Therefore, protective clothing and equipment must be worn as necessary. Must have functional speech, vision, hearing, and touch with ability to use fine hand manipulation skills for IV insertion and other procedures/functions. Operates all equipment necessary to perform the job. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.