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.
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, including housing, transportation, food assistance, and social services.
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.

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

Registered Nurse (RN) Clinical Care Manager

Key skills