Hybrid Registered Nurse

024450 Clin Alli-Care Management

Position Summary:

Commonwealth Care Alliance’s (CCA) Clinical Care Manager is a registered nurse or other independently licensed behavioral health clinician responsible for providing intensive monitoring, follow-up and clinical care management to a panel of health plan members with complex medical, behavioral, and social care needs, including Severe and Persistent Mental illness.

As part of the care management dyad, the Clinical Care Manager works directly with assigned CCA members to help them navigate the health care system, gain access to available services, and assist members with finding answers to their questions. The Clinical Care Manager functions as the clinical expert on an interdisciplinary team through close member oversight, routine and post discharge assessments, providing health education, and provider collaboration. Consults, as needed, with other participants of the interdisciplinary care team on members experiencing medical or behavioral health issues. Responsible for supporting the members in achieving their goals for independent living, recovery, and community connections.

This position allows for remote work, when possible, but does require in-person visits to members in their homes and community, as needed.

Supervision Exercised:

• No, this position does not have direct reports. 

Essential Duties & Responsibilities:

• Complex care management

• Care plan development, updates and implementation with members

• Member education

• Provider communication, including collaboration with DMH and DDS (BH)

• Routine member engagement

• Quality gap closures, including:

• RN Clinical Care Manager

• BH Clinical Care Manager

• Medication Reconciliation

• Follow up after Hospitalization (FUH)

• Blood Pressure readings

• Initiation and Engagement (IET)

• Participate in interdisciplinary care team meetings

• Performs applicable standardized assessments, including MDS, Comprehensive, Functional, and Crisis and Risk Assessments

• Perform home visits with member for routine assessments, routine clinical needs, and post transitions of care follow up that require in person evaluations

• Monitor available data for assigned members to inform proactive outreaches as well as reactive clinically appropriate assessments to ensure comprehensive knowledge of members current needs to inform continuous and meaningful updates to the care and service plan.

• Resource and expert for members regarding available benefits and resources to meet their needs.

• Clinical resource for other members of the interdisciplinary care team

• Additional duties as requested by supervisor

Working Conditions:

• Standard office conditions

• Must be able to travel to member’s homes or other community environment

• Must be able to come to the local CCA office and/or provider offices for various meetings as needed.

• Responsible to provide a strong internet connection when working remotely

Member Facing:

☒  YES: The job has in-person contact (not telephonic/virtual) with CCA members or patients as part of the job duties.

Required Education (must have):

•  RN Clinical Care Managers must have:

  •  Associate degree in nursing

  • Active RN license, in good standing, in state of assignment.

• BH Clinical Care Managers must have:

  • Master’s degree in social work or mental health counseling

  • Must have an active LCSW, LMHC or LICSW license in good standing in the state assigned; may require multiple state licenses based on product

Desired Education (nice to have):

•  Bachelor’s or Master’s degree in nursing preferred

• Other related Healthcare Degree

• Certified Care Manager (CCM)

Required Licensing (must have):

• RN Clinical Care Managers must have an Active RN license, in good standing, in state of assignment.
• BH Clinical Care Managers must have: an active LCSW, LMHC or LICSW license in good standing in the state assigned; may require multiple state licenses based on product

MA Health Enrollment (required if licensed in Massachusetts):

• Yes, this is required if the incumbent is licensed in Massachusetts. 

Required Experience (must have):

• Meaningful clinical and care management experience, including 3+ years caring for people with complex medical, behavioral and social needs

Desired Experience (nice to have):

• Experience working in a health plan, with Medicare Advantage and/or dually eligible population

• Experience with a care management platform (Guiding Care a plus)

• Experience with Substance Use Disorders

Required Knowledge, Skills & Abilities (must have):

• Proven skills, knowledge base, and judgement necessary for independent clinical decision making in alignment with clinical licensure.

• Excellent critical thinking, organizational, time management 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

• Strong customer service skills

• Ability to work in multiple systems, often simultaneously.

• Flexibility to adapt to business needs

• Motivated team player

• High attention to detail and accuracy

Required Language (must have):

• English

Desired Knowledge, Skills, Abilities & Language (nice to have):

• Ability to utilize an Electronic Medical Record or other electronic platforms

• Ability to use on-line training platforms

• Demonstrated ability to utilize virtual care platforms

• Proficiency in Microsoft Office Suite

• Bilingual preferred

Compensation Range/Target: $72,480 - $108,720

Commonwealth Care Alliance takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.