Provide monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs
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 under both Medicare and Medicaid.
Provide education to members and their families about managing chronic conditions, medication adherence, and preventive care.
Follow up with members after hospitalizations or significant health events to ensure continuity of care and prevent readmissions.
Report abuse, neglect, or exploitation of older adults and adults with disabilities as a mandated reporter.

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 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 as community resources and services available to dual-eligible beneficiaries.
Must have valid driver's license, vehicle and verifiable insurance.

Influenza vaccination is a requirement of this position.
Annual proof of Influenza vaccination for designated positions during Influenza season.
CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law.

Registered Nurse (RN) Clinical Care Manager

Key skills