Senior Manager leading Capital Modelling at QBE, enhancing strategic model use and capital insights. Drive decision - making and risk management in a hybrid role based in the UK.
About the role
- Clinical Care Manager responsible for integrating health services for enrollees with complex needs in Massachusetts. Engaging members in care management and ensuring coordination among providers and resources.
Responsibilities
- 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
- 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
- Assist enrollees in preventative health strategies
- Follow up with members after hospitalizations or significant health events
- Work closely with primary care physicians, specialists, and other healthcare providers
Requirements
- Associates of Science (A.S) degree in nursing from an accredited nursing program required
- 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.
- Must have valid driver's license, vehicle and verifiable insurance.
Benefits
- Health insurance
- Flexible working hours
- Professional development
- Bonuses
- Comprehensive total rewards package
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