Mom & Baby Care Manager - Social Worker - Must Reside In Nevada

Job Description: • 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 Requirements: • 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 • Maternity/Mother and Baby experience strongly preferred • Three (3) years Medicaid and/or Medicare managed care experience is preferred • 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 Benefits: • Substantial and comprehensive total rewards package • Bonus tied to company and individual performance • Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members • Total well-being for employees Apply tot his job