Care Guide - Hamilton County

Job Summary:

The Care Guides are responsible for participating as a member of the inter-disciplinary Care Coordination Team to coordinate care for members, meeting their individual needs and the needs of the population. The Care Guide serves as a single point of contact for care coordination when there is no CCE or OhioRISE Plan and/or CME involvement & short-term care coordination needs are identified. The Care Guide Plus serves as a single point of contact for care coordination when there is a CCE, OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. Members needing Care Guide or Care Guide Plus assistance for longer than 60 calendar days should be considered for referral to a Care Manager.

Essential Functions:

Engage with the member in a variety of settings to establish an effective, professional relationship. Settings for engagement include but are not limited to; hospital, provider office, community agency, member’s home, telephonic or electronic communication

Participate in the identification and prioritization of the individual’s care management needs and goals in collaboration with the member and caregivers.

Gather information to identify and manage barriers to achievement of care plan goals; take appropriate steps to close gaps in care where appropriate

Under the supervision of the Care Manager, implement effective interventions based on clinical standards and best practices

Participate in the development and implementation of individual care plans and participate in the development of problem focused care plan templates

Maximize the client’s health, wellness, safety, adaptation, and self-care through effective care coordination and case management

Educate the member and other stakeholders about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made

Gather information to assist the Care Manager to evaluate the member’s response to the plan of care

Evaluate client satisfaction through open communication and monitoring of concerns or issues; assist members in filing of Grievances & Appeals as appropriate

Collaborate with Care Managers 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

Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation

Starts each intervention with members wondering, “What does the world look like for this person, and how can I meet him or her where they are? What are his or her unique needs, and how can CareSource help?” In each interaction, the employee will aspire to help the member to feel informed, empowered, and supported by CareSource

Looks for ways to improve the process to make the members experience with CareSource easier and shares with leadership to make it a standard, repeatable process

Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program

Perform any other job duties as requested

Education and Experience:

Associate’s Degree or equivalent years of relevant work experience is required

Minimum of one (1) year of clinical experience in nursing, social services, or healthcare field (discharge planning, case management, care coordination, and/or home/community health experience) is required

Medicaid and/or Medicare managed care experience is preferred

Competencies, Knowledge and Skills:

Proficient with Microsoft Office, including Outlook, Word and Excel

Sensitivity to and experience working within different cultures

Good interpersonal skills

Ability to work independently and within a team environment

Ability to identify problems and opportunities and communicate to management

Developing knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices

Demonstrate compassion, support and collaboration with members and families

Self-motivated and inquisitive

Comfort with asking pertinent questions

Ability to work in a fast-paced environment

Ability to demonstrate and promote ethical conduct

Ability to develop positive relationships with all stakeholders

Awareness of community & state support resources

Organized, detail-oriented and conflict resolution skills

Ability to keep composure and professionalism during times of high emotional stress

Ability to maintain confidentiality and act in the company’s best interest

Proven track record of demonstrating empathy and compassion for individuals

Proven track record for improving processes to make things easier for those you have served

Licensure and Certification:

Clinical or Care Management Certification is preferred

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

Employment in this position is conditional pending successful clearance of a criminal background check. If the criminal background results are unacceptable, the offer will be withdrawn or, employee has started in position, employment in this position will be terminated

To help protect our employees, members, and the communities we serve from acquiring communicable diseases, full COVID-19 and Influenza vaccination is an essential 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 forty-five (45) days from their hire date to complete the required vaccination.

CareSource requires all employees to be fully vaccinated (two weeks removed from completion of a two-dose mRNA series or two weeks removed from a one dose vaccine) against the COVID-19 virus. Employees are required to disclose and provide proof of their vaccination status as a condition of continued employment. Candidates who accept an offer of employment must upload proof of vaccination prior to their start date. Failure to meet the vaccination requirement, including providing proof of vaccination prior to the start date, may result in rescission of an employment offer or termination of employment.

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 reviewed by the CareSource Health & Wellness team.

Working Conditions:

Mobile Worker: This is a mobile position, meaning that regular travel to different work locations 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.

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. A valid driver’s license, car, and insurance are necessary for work related travel

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 and may refer members to other CareSource resources

Compensation Range:$45,600.00 - $73,000.00

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. 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

Create an Inclusive Environment

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, including disability and veteran status. We are committed to a diverse and inclusive work environment.

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