Hybrid Registered Nurse (RN) - Care Delivery (Boston and Surrounding Areas)

Care Delivery RN collaborates with members of an interdisciplinary team to provide primary care, in-home specialty care, and care coordination to a specific panel of high-risk and complex patients, including individuals with significant medical, behavioral, and social complexities that require intensive care coordination and care delivery.

Responsibilities

• Delivers care to complex patients, providing care management and care coordination support, and collaborating with external providers with the goal of delivering comprehensive care.
• Conducts basic health assessments and provides direct and indirect nursing care within RN scope of practice and with signed provider’s order as necessary.
• Escalates all pertinent clinical findings to assigned APC within specified timeframes.
• Conducts follow-up telephone calls with patients to ensure satisfaction.
• Assesses quality gap reports at each face-to-face visit; collaborates with care team and PCP to close identified gaps.
• Ensures timely medical post-hospital discharge with focus on hospitalization and utilization reduction.
• Documents all visits with focus on clear, comprehensive, and concise charting while strictly adhering to policies and procedures.
• Communicates clear loop closure to the interdisciplinary care team and plans for member-centric follow-ups as indicated.
• Identifies and initializes a plan to resolve areas of opportunity to meet Key Performance Indicators (KPIs).
• Proactively and collaboratively works with the patient’s Primary Care Provider (PCP) and other external providers on key care management/care coordination decisions to ensure a cohesive medical treatment plan is delivered.
• Participates in interprofessional Care Team meetings, clinical committees, completes ongoing education and training, and provides consultation and support to other members of the Care Team.
• Assists management with the development, refinement, and enhancement of clinical programs, initiatives, processes, policies, workflows, and projects.
• Completes Health Plan assessments at scheduled and timely intervals and off-cycle as needed.
• Routinely and accurately completes the member-centric Care Plan and provides updates to PCP, Providers, and HP as required.
• Regular travel to conduct member, provider, and community-based visits as needed to ensure effective administration of the program.
• Supports the procurement of Durable Medical Equipment, transportation, LTSS services and supports, and community supports as approved.
• Supports the procurement of network providers and assists in closing any gaps in service or care.
• Performs any other job-related duties as requested.

Requirements

• Associate’s degree in nursing required; Bachelor’s degree in nursing preferred.
• Five (5) years of experience as a Registered Nurse in a high-touch clinical environment or home care required.
• Two (2) years of experience caring for patients/members with complex medical, behavioral health, and social needs required.
• Three (3) years of experience working in outreach or in the community caring for patients with complex medical, behavioral health, and social needs preferred.
• Experience with electronic medical records strongly preferred.
• Experience with disability issues preferred.
• Experience with Medicaid or Medicare programming and insurance products (i.e., ACO, MCO, PACE, or SCO) preferred.

Skills

• Excellent written and verbal communication skills.
• Ability to communicate effectively with a diverse group of individuals.
• Working knowledge of Microsoft Office applications.
• Excellent organizational skills.
• Ability to utilize an Electronic Medical Record.
• Ability to use online training platforms.
• Demonstrated understanding of Massachusetts health benefits.
• Ability to review welcome packets and obtain consent forms.
• Demonstrated understanding of LTSS.
• Proven skills and judgment necessary for independent decision-making.
• Strong organizational, time management, and problem-solving skills.
• Ability to function effectively within a multi-disciplinary team.
• Effective oral and written skills; strong interpersonal and customer relations skills.
• Ability to work with DME vendors, verifying accuracy of products and quotes.
• Demonstrated proficiency with Microsoft Excel, Word, and Outlook.
• Ability to learn and utilize telehealth technologies (video, chat, etc.) for a variety of clinical care and care management services.
• Bilingual or multi-lingual preferred.

Licensure and Certification

• Current unrestricted clinical license in Massachusetts as a Registered Nurse required.
• Basic Life Support Certification required.
• Must have a valid driver’s license, vehicle, and verifiable insurance.
• 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 employment has started, it will be terminated.
• Influenza vaccination is required annually (October 1 – March 31) as a condition of continued employment. Employees hired during this period will have thirty (30) days from their hire date to complete the required vaccination and verify immunization.

Working Conditions

• This is a mobile position, meaning regular travel to different work locations, including homes, offices, or other public settings, is essential.
• Exposure to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
• Must reside in the same territory assigned to work in; exceptions may be considered due to business need.
• May be required to travel greater than 50% of the time to perform work duties.
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer.
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of members.
• The employee must frequently lift and/or move up to ten pounds and occasionally lift and/or move more than one hundred pounds.
• Over 50% mobile; routine travel required.

Pay

$62,700.00 - $100,400.00 annually. CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, discretion, and latitude required for the role when establishing salary. In addition to base compensation, you may qualify for a bonus tied to company and individual performance.

Benefits

CareSource offers a substantial and comprehensive total rewards package.