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, providing routine updates as the enrollee’s status changes
Lead the interdisciplinary care team (ICT) and collaborate with peers to create holistic care plans
Advocate for the needs and preferences of enrollees within the healthcare system
Provide education to members and their families about managing chronic conditions, medication adherence, and preventive care
Follow up with members after hospitalizations or significant health events

Associates of Science (A.S) degree in nursing from an accredited nursing program required
A Registered Nurse with the ability to independently serve people with complex medical, behavioral, and social needs required
Prior experience in care coordination, case management, or working with dual-eligible populations preferred
Medicaid and/or Medicare managed care experience preferred
Clinical Field/ Community Based Training a Plus
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.
Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers

Registered Nurse (RN) Clinical Care Manager

Key skills