Hybrid Primary Care Triage Registered Nurse; RN - Massachusetts

Commonwealth Care Alliance® (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of Care Source, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises.

CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care®, which yields improved quality outcomes and lower costs of care.

The Care Delivery Triage RN is responsible for performing telephonic clinical triage and providing health information service and care coordination as a key part of the primary care team, and acts as the primary liaison with Care Partnership and external care team members when communicating clinical and care management needs.

• Serves as primary telephonic contact person for clinical and care coordination needs, maintaining timely accurate documentation.
• Evaluates and assesses health care needs utilizing established triage protocols and documented workflows.
• Escalates issues to APC/physician based on triage protocol disposition, documented workflows, or nursing judgment.
• Coordinates and schedules appointments based on triage disposition or as requested by the care team.
• Provides telephonic education to patient and family regarding chronic disease management and follow-up preventive health maintenance.
• Serves as primary point of contact with Care Partnership in coordinating health plan activities and care management needs.
• Participates in the coordination of referrals, specialty visits, testing, social services, and skilled services.
• Communicates and follows up with skilled services on new/routine orders and chronic disease management.
• Assists administrative staff in identifying VNA vendors when needed.
• Performs telephonic follow-up of inpatient and ED care.
• Attends and participates in team meetings as directed.
• Utilizes nursing judgement and/or provider order in order to refer to internal and external auxiliary resources such as CCA clinical group CHW, Rehab, Nursing and APCs, home based lab services, inst
  
  Ed, pharmacies, etc.
• Takes a primary role in coordinating gap closure activities.
• Communicates lab results and other medical advice with direction from the APC or physician.
• Assists with logistical planning for vaccination efforts or other clinical initiatives.
• Assists the APC/physician with submitting lab orders and follow-up as delegated.
• May be cross-trained to provide backup support to other areas of nursing within practice, including but not limited to clinic‑based care and field support.
• Perform any other job related duties as requested.

• Associates degree in nursing required
• Bachelor's degree in nursing preferred
• Three (3) years of experience as Registered Nurse in a high touch clinical environment or home care required or
• Two (2) years of experience caring for patients/members with complex medical, behavioral health, and social needs required

• Strong computer skills
• Strong clinical assessment skills
• Strong communication skills
• Ability to work independently and within a team environment
• Attention to Detail
• Critical listening and thinking skills
• Decision making/problem solving skills
• Proper phone etiquette
• Customer service oriented
• Broad base of clinical knowledge
• Teaching skills
• Ability to remain calm under pressure and in member life‑threatening situations
• Ability to apply multiple communicative skills while utilizing available tools and resources simultaneously
• Ability to effectively work with patients with various cognitive, physical, and behavioral abilities
• Ability to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services

• Current, unrestricted RN licensure in Massachusetts required
• To help protect our employees, members, and the communities we serve from acquiring…