RN Field Clinical Care Coordinator

Role: RN Field Clinical Care Coordinator responsible for assessing, planning, and managing individualized care strategies for members within an Integrated Care Model. Responsibilities: Engage members face-to-face or telephonically to conduct comprehensive needs assessments, including medical, behavioral, functional, cultural, and socioeconomic factors. Initiate referrals to social services, coordinate care plans across providers and community resources, and serve as the primary contact throughout the care continuum. Communicate effectively with stakeholders to ensure timely, quality care delivery. Qualifications & Skills: Current unrestricted RN license in MA, 2+ years clinical experience, proficiency with MS Office, reliable internet and transportation, and ability to travel locally. Preferred qualifications include a Bachelor's or Master's in Nursing, CCM certification, community case management experience, bilingual skills, and familiarity with electronic medical records. Physical & Work Environment: Ability to work in both office and field settings, visit members in their homes or community locations, transport equipment, and work in fast-paced environments. Telecommuting is permitted in accordance with company policies.