The Clinical Care Manager is responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs.
Engage with the enrollee in their homes and other community settings to establish a complex care management relationship.
Function as a liaison between healthcare providers, community resources, and enrollees.
Perform required assessments on a timely basis, including Comprehensive Assessment, MDS-HC (or successor) Functional Assessments, and Crisis and Risk Assessments.
Lead the interdisciplinary care team (ICT) to create holistic care plans.
Oversee enrollee utilization of long-term services and supports.
Assist members in accessing community resources like housing, food assistance, etc.
Provide education to members and families about managing chronic conditions and preventive care.
Follow up with members after hospitalizations to ensure continuity of care.
Advocate for the needs and preferences of enrollees within the healthcare system.

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.
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.
Influenza vaccination is a requirement of this position.

Registered Nurse, Clinical Care Manager

About this role