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- Boston, MA 02129
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RN Care Manager- Boston Area (Field Role)
RCM Healthcare Services • Boston, MA
Posted 4 days ago
A well-known and reputable health plan that provides health insurance coverage to Massachusetts residents. They are looking for several RN Care Managers for their Senior Care Options Program.
Salary Range $83,000 to $96,000 (depending on experience)
Job Summary: In this role, the Care Manager, Senior Care Options will perform a variety of diverse and complex face to face and telephonic care management responsibilities. The Care Manager's work will primarily be conducted in the field and working remotely/in a work from home environment. The Care Manager will act as the medical clinician link within the Primary Care Team (PCT) in partnership with the Enrollee, the Geriatric Supports Services Coordinator (GSSC), Behavioral Health Strategies staff, non-clinicians, pharmacists, medical directors and others. The Care Manager will be the medical lead for the team in the completion of assessments and re-assessments, and the development of the person-centered Individualized Plan of Care (IPC). The Care Manager will manage the Enrollee through the health care continuum, including acting as the liaison for hospital staff, community based organizations and Aging Services Access Points (ASAPS), the primary care provider and other members of the PCT.
• Completes initial and on-going face to face comprehensive assessment with Enrollees
• Demonstrates strong knowledge and use of the MDS-HC assessments to maximize placement of Enrollees into the appropriate rating category
• In conjunction with the Enrollee and the PCT develops a person centered Integrated Plan of Care
• Facilitates meetings of the PCT
• Utilizes evidence-based guidelines to assist Enrollees in understanding their disease process and increase their capacity for self-management and optimal health
• Utilizes evidence-based guidelines to develop Individualized Plans of Care (IPC)
• Evaluates the effectiveness of the IPC and progress against goals
• Serves as designated medical clinical care subject matter expert on the PCT
• Evaluates the effectiveness of alternative care services and ensures that cost effective, quality care is maintained according to standards
• Facilitates linkage and referral to ASAPS and other community based organizations
• Documents clinical assessments and coordination of care in the medical management information system in a timely manner that meets regulatory and accreditation standards
• Ensures continuity of care through effective transition planning
• Provides culturally competent care coordination in keeping with the Enrollee's racial, ethnic and sexual orientation
• Utilizes data to ensure that clinical interventions result in improved clinical outcomes and appropriate utilization of services at the right time, right place, and right setting
• Facilitates sharing of essential clinical or psychosocial information related to the Enrollee's care
• Maintains HIPAA standards and confidentiality of protected health information.
• Registered nurse
• Bachelor's degree or an equivalent combination of education, training and experience is required.
• Master's degree in nursing, geriatric NP, or health related/public health field preferred
• Certification in case management (CCM) preferred
• Bilingual Spanish, Haitian Creole, Spanish Creole, French Creole
• 3 years' experience in Medical Case Management working with the geriatric population90% field, 10% remote (after 6 months)