HAP CareSource is a joint venture between Health Alliance Plan (HAP) a Michigan-based health plan that provides health coverage to individuals and companies of all sizes, and CareSource a nationally recognized managed care organization with more than 2 million members. HAP CareSource extends and enhances the mission-based legacies of two trusted, midwestern nonprofit organizations - offering comprehensive health coverage, access to physicians and quality care with compassion. The joint venture enables HAP CareSource to provide more Michiganders access to award-winning products, services and an expanded provider network and to expand services to Medicaid-eligible individuals in the Lower Peninsula.
Wayne County
Job Summary:
The Community Based Waiver Service Coordinator-Duals Integrated Care is responsible for managing and coordinating services for individuals who require long-term care support and are eligible for community-based waiver programs, ensuring that members receive the necessary services and supports to live independently in their communities while also coordinating care across various healthcare and social service systems.
Essential Functions:
Engage with 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.
Conduct comprehensive assessments to determine the needs of members eligible for community-based waiver services.
Develop individualized service plans that outline the necessary supports and services, ensuring they align with the individual's preferences and goals.
Serve as the primary point of contact for members and their families, coordinating care across multiple providers and services, including healthcare, social services, and community resources.
Facilitate access to necessary services such as home health care, personal care assistance, transportation, and other community-based supports.
Regularly monitor the implementation of service plans to ensure that services are being delivered effectively and that individual needs are being met.
Conduct follow-up assessments to evaluate the effectiveness of services and make adjustments to person-centered care plans as needed.
Advocate for the rights and needs of members receiving waiver services, ensuring they have access to the full range of benefits and supports available to them.
Empower members and their families/caregivers to make informed decisions about their care and support options.
Build and maintain relationships with healthcare providers, community organizations, and other stakeholders to facilitate integrated care.
Lead and collaborate with interdisciplinary care team (ICT) to discuss individual cases, coordinate care strategies, and create holistic care plans that address medical and non-medical needs.
Provide education and resources to members and their families/caregivers about available services, benefits, and community resources.
Offer guidance on navigating the healthcare system and accessing necessary supports.
Maintain accurate and up-to-date records of member interactions, care/service plans, and progress notes.
Assist in preparation of reports and documentation required for compliance with state and federal regulatory requirements.
Respond to crises or emergencies involving members receiving waiver services, coordinating immediate interventions and support as needed.
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.
Regularly verify and collaborate with Job and Family Service to establish and/or maintain Medicaid eligibility.
On-call responsibilities as assigned.
Perform any other job related duties as requested.
Education and Experience:
Nursing degree from an accredited nursing program required or
Bachelor's degree in health care field required
Equivalent years of relevant work experience may be accepted in lieu of required education
One (1) year paid clinical experience in home and community based services required
Medicaid and/or Medicare managed care experience preferred
Competencies, Knowledge and Skills:
Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel
Prior experience in care coordination, case management, or working with dual-eligible populations is highly beneficial
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
Awareness of and sensitivity to the diverse backgrounds and needs of the populations served
Ability to manage multiple cases and priorities while maintaining attention to detail
Adhere to code of ethics that aligns with professional practice, including maintaining confidentiality
Decision making and problem-solving skills
Knowledge of local resources for older adults and persons with disabilities
Licensure and Certification:
Current and unrestricted license as a Registered Nurse or Social Work licensure in the State assigned required
Case Management Certification is highly preferred
Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful... 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.
