Hybrid Registered Nurse (RN) Clinical Care Manager - Acton and surrounding areas - R13184-1

About the role

The Integrated Care Clinical Manager - Massachusetts at CareSource/Commonwealth Care Alliance (CCA) is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs.

Responsibilities

• Engage with the enrollee in their homes and other community settings to establish an effective, complex care management relationship, while considering the cultural and linguistic needs of each member.
• Function as a liaison between healthcare providers, community resources, and enrollees to ensure seamless communication and care transitions.
• Perform required assessments on a timely basis, including but not limited to Comprehensive Assessment, MDS-HC (or successor) Functional Assessments, and Crisis and Risk Assessments.
• Engage enrollees in care plan development and implementation, providing routine updates as the enrollee’s status changes.
• Lead the interdisciplinary care team (ICT) and collaborate with peers both internal and external to the organization, to create holistic care plans that address medical and non-medical needs.
• Oversee enrollee utilization of long-term services and supports, ensuring appropriate systems are in place for enrollees to remain in the location of their choice.
• Aid members in accessing community resources, including housing, transportation, food assistance, and social services.
• Educate members about their benefits and available services under both Medicare and Medicaid.
• Provide education to members and their families about managing chronic conditions, medication adherence, and preventive care.
• Promote healthy lifestyle choices and self-management strategies.
• Assist enrollees in preventative health strategies, including gap closure.
• Follow up with members after hospitalizations or significant health events to ensure continuity of care and prevent readmissions.
• Work closely with primary care physicians, specialists, and other healthcare providers to coordinate care and share relevant information.
• Coordinate with community-based organizations, other stakeholders/entities, state agencies, and other service providers to ensure coordination and avoid duplication of services.
• Advocate for the needs and preferences of enrollees within the healthcare system.
• Evaluate member satisfaction through open communication and monitoring of concerns or issues.
• Regular travel to conduct member, provider and community-based visits as required.
• Report abuse, neglect, or exploitation of older adults and adults with disabilities as a mandated reporter as required by State law.
• Adhere to NCQA and Care Management standards.

Requirements

• Associates of Science (A.S) degree in nursing from an accredited nursing program required.
• A Registered Nurse with the ability to independently serve people with complex medical, behavioral, and social needs.
• Prior experience in care coordination, case management, or working with dual-eligible populations preferred.
• Medicaid and/or Medicare managed care experience preferred.
• Clinical Field/ Community Based Training a Plus.

Qualifications

• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel.
• Understanding of Medicare and Medicaid programs, as well community resources and services available to dual-eligible beneficiaries.
• Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers.
• Ability to manage multiple cases and priorities while maintaining attention to detail.
• Adhere to code of ethics that aligns with professional practice.
• Awareness of and sensitivity to the diverse backgrounds and needs of the populations served.
• Decision making and problem-solving skills.
• Ability to function independently and effectively as part of an interdisciplinary team.
• Strong and effective communication skills, both written and verbal.
• Strong interpersonal and customer relations skills.
• Strong customer service skills.

Skills

• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel.
• Understanding of Medicare and Medicaid programs, as well community resources and services available to dual-eligible beneficiaries.
• Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers.
• Ability to manage multiple cases and priorities while maintaining attention to detail.
• Adhere to code of ethics that aligns with professional practice.
• Awareness of and sensitivity to the diverse backgrounds and needs of the populations served.
• Decision making and problem-solving skills.
• Ability to function independently and effectively as part of an interdisciplinary team.
• Strong and effective communication skills, both written and verbal.
• Strong interpersonal and customer relations skills.
• Strong customer service skills.

Benefits

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.

Pay

$90,000 - $120,000

Schedule

Routine travel required.