Care Guide - NE Ohio

Care Guide Position

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 of the individual's needs and prioritizes efforts in collaboration with the member and caregivers.
• Gather information to identify and manage barriers to care
• 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
• Maximize the client's health, wellness, safety, adaptation, and self-care through effective care coordination
• 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 as requested
• 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 Care Source policies regarding professional documentation
• Starts each interaction 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 Care Source help?" In each interaction, the employee will aspire to help the member to feel informed, empowered, and supported by Care Source
• Looks for ways to improve the process to make the members experience with Care Source 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; active, unrestricted allied health certification or LPN license may be considered in lieu of Associate's Degree
• 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…