Registered Nurse; RN Clinical Care Manager

Responsibilities

• 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.
• 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.
• 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.
• 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.

• 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

Demonstrates expertise in care coordination and case management, with a strong focus on addressing the complex medical, behavioral, and social needs of enrollees. Proficient in conducting comprehensive assessments and leading interdisciplinary care teams to develop holistic care plans.

• Registered Nurse (RN) License
• Care Coordination
• Case Management
• Medicaid Experience
• Medicare Experience

• Comprehensive Assessment
• MDS‑HC Functional Assessment
• Crisis Assessment
• Risk Assessment
• Preventative Health Strategies

• Effective Communication
• Cultural Competence
• Collaboration
• Education and Advocacy

• Associates of Science (A.S) Degree in Nursing
• Master's Degree in Social Work or Mental Health Counseling

• Dual-Eligible Populations
• Interdisciplinary Care Team (ICT)
• Community Resources
• Health Transitions
• Self-Management Strategies