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, including but not limited to Comprehensive Assessment, MDS-HC (or successor) Functional Assessments, and Crisis and Risk Assessments
Engage enrollees in care plan development and implementation, providing routine updates as the enrollee’s status changes
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
Oversee enrollee utilization of long-term services and supports, ensuring appropriate systems are in place for enrollees to remain in the location of their choice
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

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
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

Registered Nurse (RN) Clinical Care Manager

Key skills