Caregiver Full-time
CareSource

Hybrid Care Coordinator, Massachusetts

CareSource Boston, MA
$47,400 - $76,000 / year
Job Summary: The Care Coordinator - Massachusetts is the primary point of contact for a stratified panel of members whose role is to assist enrollees in navigating their health care providing care planning and coordination of services, ensuring timely service delivery and prompting continuity of care through coordinated outreach and engagement with members and providers. This role is responsible for routine enrollee outreach, including community-based visits, telephonic or virtual visits, documenting service activities, and supporting administrative functions that enhance member satisfaction. Seeking candidates in South and North Shore, Plymouth County as well as Boston Essential Functions: Serve as the first point of contact for enrollees, including assisting enrollees with understanding health plan processes, appeals and grievances and assist with removing barriers to getting needed services Conducts routine outreach to members and providers to confirm service details, coordinates services with long term services and supports teams, , serves as a health plan subject matter expert and accurately documents care coordination activities. Provides in-person visits to enrollees at least annually, with member consent Maintain open lines of communication with enrollees, as needed based on Enrollee preferences Maintains accurate and timely documentation and internal systems to ensure visibility across teams and continuity of service. Coordinates provider and member scheduling efforts, supports high-volume outreach campaigns, and ensures task completion across multiple systems Identify potential social support or community-based needs Lead the interdisciplinary care team (ICT) for a stratified panel of members, collaborating with team members internal and external to the organization to create an enrollee centered care plan Provide education on plan benefits and service options Serves as a support resource for enrollees and providers, and escalate concerns by coordinating responses and ensuring issues are routed or addressed promptly Collaborates with clinical care managers, behavioral health clinicians, community health workers, providers, and external partners as needed to ensure smooth communication and continuity across care activities Gather and document service-related information during members interaction to support care coordination, service planning, or referral processes Maintain accurate documentation and maintenance of the centralized enrollee records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners as needed Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements Ensure enrollees follow up with providers, including assistance with appointment scheduling and verification of transportation Facilitate communication and information exchange with the member and their providers and community supports Performs any other job related duties as requested. Education and Experience: High School or GED required Two (2) years of experience in healthcare, customer service or a related industry required Competencies, Knowledge and Skills: Basic proficiency with Microsoft Office Suite to include Outlook, Word and Excel Knowledge of Medicaid, Medicare and Managed Care is preferred Customer service focus with exceptional listening, written and verbal communication skills Displays professional phone etiquette Ability to multitask using a variety of computer applications Strong organizational skills Effective problem solving skills with attention to detail Ability to work independently and within a team environment Understanding and supportive of managed care concept Adaptable to a constantly changing environment Able to type (document) and talk (telephonically) simultaneously Licensure and Certification: 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. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated 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. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process. Working Conditions: This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time. Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need May be required to travel greater than 50% of time to perform work duties. Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members Over 50% (Mobile) Routine travel required Compensation Range: $47,400.00 - $76,000.00 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): Hourly 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.
RN Mother-Baby Full-time
CareSource

Mom & Baby Care Manager - Must Reside in Mississippi

CareSource MS
$56,430 - $90,360 / year
TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the state and supported by CareSource’s national leadership in quality and operational excellence. TrueCare offers locally based provider services through provider engagement representatives and customer care. Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care. By doing so, TrueCare will change the way health care is delivered in Mississippi. 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 (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 Three (3) years maternity experience 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 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: $56,430.00 - $90,360.00 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. #LI-JS1
NP Part-time
CareSource

instED Virtual Medical Control (VMC) Nurse Practitioner - POOL((Part Time - $91.67 per hour/Remote/Pacific or Mountain Time)

CareSource OR
Job Summary: Reporting to the Chief Medical Officer of instED, the Virtual Medical Control (VMC) Nurse Practitioner provides medical decision making, including all elements of diagnostics, treatment, and disposition, to patients seen by instED's Mobile Integrated Healthcare service. The VMC serves as the clinician of record, prescribes short-term treatments, documents the encounter in instED's medical record, and relays any essential follow-up needs to the care team via the instED Clinical Resource Center (CRC) team. Essential Functions: Provide patient-centered, high-quality acute care in place to individuals with complex medical needs per clinical protocols Work closely with mobile integrated healthcare clinicians (paramedics and EMTs) and other instED team members Participate in scheduled operational or clinical meetings, based on schedule availability, to remain up to date on programmatic and company activities and implications for clinical practice Collaborate with other VMCs, and with CRC team members as needed, primarily around managing visit volumes and clinical questions Provide clinical and operational feedback to management team to improve care delivery Collaborate with referring Care Partners and Primary Care Providers Document visit within the EMR in a complete, accurate, and timely manner. Documentation should include relevant data, medical decision making, and follow-up needs Provide clinical care to patients via various telehealth technologies (telephonic, video, direct messaging) Perform any other job related duties as requested. Education and Experience: Master of Science (M.S) Nursing required Doctoral Nursing preferred Five (5) years Working independently as a Nurse Practitioner in urgent care, emergency medicine, or hospital medicine required Experience caring for medically and socially complex patients required Experience working collaboratively with a variety of professionals required Experience providing non-face-to-face care, especially in telephone or virtual care required Experience working with EMS professionals (paramedics/EMTs) preferred Competencies, Knowledge and Skills: Ability to virtually/remotely assess medically complex patients Ability to provide person-centered, medically and clinically appropriate care options to patients Willingness to learn best practice in delivering home-based care Comfort with remote care delivery model and technology Comfort with shared decision making and patient-centered consideration of risk Ability to virtually/remotely assess medically complex patients Ability to work in a team-based care delivery model Strong written and verbal communication skills Comfort with Health IT and EHR systems Adaptability to change in systems and workflows Innovative, team-player, and expert communicator Ability to speak/read/write English fluently Licensure and Certification: Active Nurse Practitioner License or ability to obtain active licensure in states instED is operational required Active board certification in Family Practice, Acute Care or Adult-Gerontology required Current DEA registration required MA Health Enrollment required if licensed in Massachusetts required Current BLS Certification required Working Conditions: General office environment; may be required to sit or stand for extended periods of time May be required to work additional hours and/or outside normal business hours as needed to meet deadlines. Ability to work day and evening shifts on weekdays, weekends and holidays Travel is not typically required Compensation Range: $83,000.00 - $132,800.00 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): Hourly 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.
RN Part-time
CareSource

Registered Nurse (RN), instED Clinical Response Unit - Oregon ONLY

CareSource OR
$72,200 - $115,500 / year
Job Summary: instED provides patient-centered, high-quality acute care in place to adults with complex medical needs. The RN, instED Clinical Resource Center, will provide telephonic triage services to a diverse population to ensure referrals are clinically appropriate. In addition, the RN will track lab results and respond to clinical questions related to referrals and services. The instED RN will engage with patients, clinicians, and care partners who call with urgent clinical needs. Essential Functions: Deliver safe, compassionate, timely telephonic nurse triage care for adults with complex medical histories. Utilize excellent clinical judgment to prioritize referrals based on acuity and other factors, in accordance with instED policies and procedures. Identify emergent situations and facilitate referrals to the emergency department when clinically indicated. Provide appropriate clinical advice and teaching. Review lab results and track all labs ordered to ensure every lab is resulted and patients are notified appropriately, collaborating with instED physicians and nurse practitioners as needed. Communicate with patients to provide education and instructions regarding any recommended follow-up care. Complete accurate and appropriate documentation in real-time. Participate in Quality Assurance activities in to improve care delivery and patient experience. Participate in the development and design of the instED Now platform offering feedback and suggestions for improvement. Perform any other job related duties as requested. Education and Experience: Bachelor's degree in Nursing required One (1) year of experience triaging adults who are acutely ill or injured required Five (5) years of relevant experience as a registered nurse required Experience in urgent care or emergency department preferred Experience delivering care in a patient's home preferred Call center/telephonic triage experience preferred Quality and process improvement experience preferred Competencies, Knowledge and Skills: Experience excelling in a fast-paced healthcare delivery environment Strong telephonic triage skills demonstrating sound clinical judgment Proven ability to adapt quickly to changing workflows while maintaining a positive attitude Ability and desire to work effectively with a diverse patient population including, but not limited to race, ethnicity, gender identity, socioeconomic status, disability, veteran status, and/or limited English proficiency Ability to clearly communicate verbally with demonstrated success de-escalating callers who are upset, and always providing high-quality customer service Willingness to learn best practices in delivering home-based and telehealth care Ability to document detailed and clearly understood triage notes utilizing best nursing practices Experience working collaboratively as a team-player Fluency in Spanish or Portuguese preferred Licensure and Certification: Current licensure as a Registered Nurse (RN) and ability to obtain active licensure in states instED is operational required Must be willing to obtain a Massachusetts Registered Nurse (RN) license immediately upon hire, and other state licenses, as needed required Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $72,200.00 - $115,500.00 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): Hourly 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.