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, providing routine updates as the enrollee’s status changes
Lead the interdisciplinary care team (ICT) and collaborate with peers to create holistic care plans
Oversee enrollee utilization of long-term services and supports
Assist members in accessing community resources
Educate members about their benefits and available services under both Medicare and Medicaid.
Follow up with members after hospitalizations or significant health events to ensure continuity of care

Associates of Science (A.S) degree in nursing from an accredited nursing program required or 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.

RN Clinical Care Manager

Key skills