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, 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
• Assist 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
• Report abuse, neglect, or exploitation of older adults and adults with disabilities as a mandated reporter as required by State law

Requirements

• 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
• 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

• Health insurance
• Flexible work hours
• Professional development opportunities
• Influenza vaccination requirement
• Annual proof of Influenza vaccination for designated positions