Process Guide Jobs Near Me

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 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 CareSource 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 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; 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 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, including but not limited to: LPN, CNA/STNA, Med Assistant, Med Tech, Pharm Tech, EMT, Radiology Technician, Dietician
• 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, Influenza vaccination is a 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 thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• 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 completed through an interactive review process.

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:

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. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business