Clinical Care Manager managing nursing responsibilities for dually-eligible enrollees with complex needs. Engaging with members in community settings and coordinating care through interdisciplinary teams.
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
Perform required assessments on a timely basis
Lead the interdisciplinary care team (ICT)
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
Promote healthy lifestyle choices and self-management strategies
Follow up with members after hospitalizations or significant health events to ensure continuity of care
Advocate for the needs and preferences of enrollees within the healthcare system
Evaluate member satisfaction through open communication and monitoring of concerns or issues
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
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.
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