Registered Nurse (RN), Clinical Care Manager

Role Overview

• Engage with the enrollee in their homes and other community settings to establish an effective, complex care management relationship
• 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
• Engage enrollees in care plan development and implementation
• Lead the interdisciplinary care team (ICT) and collaborate with peers both internal and external to the organization
• Oversee enrollee utilization of long-term services and supports
• Assist members in accessing community resources
• Educate members about their benefits and available services
• 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
• Follow up with members after hospitalizations or significant health events
• Work closely with primary care physicians, specialists, and other healthcare providers to coordinate care
• 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.
• Adherence to NCQA and Care Management standards

Requirements

• Associates of Science (A.S) degree in nursing from an accredited nursing program required
• Master's degree in social work or mental health counseling and independent license required
• Three (3) years of experience as a Registered Nurse/BH Clinician or One (1) year as a Registered Nurse/BH Clinician with two (2) years of experience working with people with complex medical, behavioral and social needs as an LPN, CHW, MA required
• Prior experience in care coordination, case management, or working with dual-eligible populations preferred
• Medicaid and/or Medicare managed care experience preferred
• 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
• Must have valid driver's license, vehicle and verifiable insurance.

Benefits

• Substantial and comprehensive total rewards package
• Influenza vaccination required during season