Community based Registered Nurse focusing on clinical care management for dually-eligible enrollees with complex needs. Engaging enrollees and coordinating with healthcare providers for improved health outcomes and quality of life.
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
Engage enrollees in care plan development and implementation
Lead the interdisciplinary care team (ICT) and collaborate with peers to create holistic care plans
Oversee enrollee utilization of long-term services and supports
Assist members in accessing community resources
Educate members about their benefits and available services
Provide education to members and their families about managing chronic conditions
Promote healthy lifestyle choices and self-management strategies
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 to coordinate 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
Report abuse, neglect, or exploitation of older adults and adults with disabilities
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
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
Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers
Ability to manage multiple cases and priorities while maintaining attention to detail
Adhere to code of ethics that aligns with professional practice
Awareness of and sensitivity to the diverse backgrounds and needs of the populations served
Decision making and problem-solving skills
Ability to function independently and effectively as part of an interdisciplinary team
Strong and effective communication skills, both written and verbal
Strong interpersonal and customer relations skills
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