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RN Case Manager Unify at Integrated Resources, Inc

RN Case Manager Unify

Integrated Resources, Inc Watertown, MA Contractor
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Job Name: RN Case Manager Unify(Remote)
Job Location: Remote
Duration – 3 Months possibly extension
 
Job Description:
  • The Unify RN Care Manager utilizes advanced clinical judgment and critical thinking skills to lead an integrated care team to deliver quality care and improve outcomes for a dually-eligible members under the age of 65 within an innovative and integrated model of care.
  • The Nurse CM directly interfaces with providers, other members of the care team, members and their caregivers in identifying risk factors, developing and implementing care plans and managing all aspects of member care to promote effective utilization of available resources, optimal member functioning and cost-effective outcomes.
  • The RN will lead a team of BH care managers, care coordinators, community health workers and peer supports to ensure that members receive the highest quality of care at the right time and in the right location. Previous case management, LTSS and One Care or Medicaid experience required. RN or BSN required. CCM preferred.
 
Additional Information:
  • Responsible for leading an integrated care team in providing patient screening, care planning, and care management
  • Uses results from risk stratification, knowledge of team capacity and caseloads and awareness of team skill sets to assign members to appropriate members of the care team as the lead relationship manager •
  • Responsible for maintaining integrated care plans and managing team caseloads •
  • Responsible for LTSS service recommendations and treatment decisions based on the outcome of the LTSS assessment
  • Responsible for the delivery of interventions and oversight of member relationships, including delegation to appropriate members of the care team •
  • Responsible for serving as a resource for physicians, the care team, members, and their caregivers •
  • Identifies, eliminates, and implements solutions to barriers to care •
  • Collaborates with care team to complete medication reconciliation and manage medication adherence •
  • Collaborates with care team in coordination of care and care planning in the transitions of care, identifies new interventions based on member goals •
  • Prioritizes interventions based on member acuity and risk of avoidable utilization
  • Participates in risk management activities, including identifying and communicating issues of risk in a timely manner
  • Uses results from risk stratification, knowledge of team capacity and caseloads and awareness of team skill sets to assign members to appropriate members of the care team as the lead relationship manager
 
Care Management for High Risk Members
  • Provides care management and care coordination across multiple settings •
  • Facilitates care for patients across the healthcare continuum by utilizing a collaborative, interdisciplinary process to coordinate, monitor and plan care •
  • Conducts disease coaching, provides education to members and is clinically proficient in the management of multiple common co-morbidities •
  • Collects and analyzes related data, as needed Fosters a therapeutic and safe environment for patients and families
 
Education: (Minimum education required)
  • Registered Nurse with current unrestricted Massachusetts license required
  • Baccalaureate Degree in Nursing
  • Master's in Nursing and certification in a specialty area  
 
Experience: (Years of experience)
  • Minimum 5 RN care management experience required
  • Experience in Medicare and/or Medicaid managed care required.
  • Ambulatory care, high-risk population, and/or transitions of care experience
  • Care management for dually eligible members
  • Experience within One Care •
  • Involvement in program/project development •
  • Bilingual language skills strongly preferred
 

Recommended skills

Registered Nurse Certified
Nursing
Medicaid
Medicare
Medicaid Managed Care
Case Management
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Job ID: 20-15590

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