Job Summary:
The Community Based Care Coordinator, Duals Integrated Care is responsible for managing and coordinating care for dual-eligible beneficiaries, those who qualify for both Medicare and Medicaid. This position focuses on integrating health services and community resources to improve health outcomes and enhance the quality of life for individuals with complex health needs. More specifically, this Quality-focused role carries an enhanced responsibility for supporting HEDIS performance, proactively identifying and closing gaps in care, and driving key quality outcomes across the dualeligible population.
Essential Functions:
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.
Performs any other job related duties as requested.
Education and Experience:
Nursing degree from an accredited nursing program required or
Bachelor's degree in a health care field required
Equivalent years of relevant work experience may be accepted in lieu of required education
Previous experience in nursing, social work, counseling or health care profession (i.e. discharge planning, case management, care coordination, and/or home/community health management) experience required
Prior experience in care coordination, case management, or working with dual-eligible populations preferred
Medicaid and/or Medicare managed care experience preferred
Competencies, Knowledge and Skills:
Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
Understanding of Medicare and Medicaid programs, as well community resources and services available to dual-eligible beneficiaries
Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers
Ability to manage multiple cases and priorities while maintaining attention to detail
Adhere to code of ethics that aligns with professional practice
Awareness of and sensitivity to the diverse backgrounds and needs of the populations served
Decision making and problem-solving skills
Licensure and Certification:
Current, unrestricted clinical license in state of practice as a Registered Nurse, Social Worker or Clinical Counselor required
Licensure may be required in multiple states as applicable based on State requirement of the work assigned
Case Management Certification is highly preferred
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... For full info follow application link.
CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.
