CareSource

Manager

• Provide monitoring, follow-up, and clinical care management to dual-eligible enrollees with complex medical, behavioral, and social needs
• Engage enrollees in homes and community settings and establish complex care management relationships
• Coordinate communication and care transitions among healthcare providers, community resources, and enrollees
• Perform Comprehensive, MDS-HC or successor Functional, Crisis, and Risk Assessments
• Develop, implement, and update enrollee care plans
• Lead interdisciplinary care teams and create holistic plans addressing medical and non-medical needs
• Oversee utilization of long-term services and supports
• Assist members with housing, transportation, food assistance, and social services
• Educate members about Medicare, Medicaid, benefits, chronic conditions, medication adherence, preventive care, and self-management
• Support preventive health strategies and gap closure
• Follow up after hospitalizations and significant health events to promote continuity of care and prevent readmissions
• Coordinate with physicians, specialists, healthcare providers, community organizations, state agencies, and other stakeholders
• Advocate for enrollee needs and preferences
• Evaluate member satisfaction and monitor concerns
• Conduct regular member, provider, and community-based visits, with travel over 50% of the time as required
• Report abuse, neglect, or exploitation as a mandated reporter under state law
• Adhere to NCQA and Care Management standards
• Perform other job-related duties as requested

RN Care Manager