Hybrid Registered Nurse (RN) or BH Case Manager - Chicopee / Springfield

Commonwealth Care Alliance; Springfield (MA); Remote; USD 50,000 - 70,000; Full time

Job summary

A healthcare provider is seeking a Care Partner to provide care coordination and management for members from various benefit programs. The role involves chronic disease management, telehealth services, and liaising with interdisciplinary teams to ensure quality care. Candidates should have experience in care management and be comfortable working remotely.

Qualifications

• Experience in care management and coordination.
• Ability to provide telephonic support and assessments.
• Familiarity with community resources and benefits.

Responsibilities

• Facilitate preventative and basic primary care as needed.
• Coordinate benefits such as transportation and hospice services.
• Participate in CCA quality improvement efforts.

Skills

Chronic disease management

Care coordination

Telehealth technology use

Preventative care

Job description

Why This Role is Important to Us

Commonwealth Care Alliance's (CCA) Care Partner is primarily responsible for providing comprehensive care coordination and care management to CCA members from one or more CCA benefit programs.

The Care Partner provides care management, and care coordination to a defined panel of CCA members and is the primary clinical and care management provider for this panel of members. Responsibilities include comprehensive care management, chronic disease management, preventative care and wellness, liaison with other relevant providers around behavioral health and long-term service and support needs, and the provision (with support) of end of life / palliative care, as needed. This role also includes a compendium of care management / care coordination functions encompassing the development and implementation of the member-centered individualized care plan, along with oversight and authorization of appropriate services and supplies. Supervision Exercised : None

What You\'ll Be Doing

• Facilitate preventative and basic primary care to members, as needed, per CCA standard operating procedures, commonly accepted medical guidelines, and appropriate scope of practice.
• Provide regularly scheduled telephonic calls to support the management of chronic disease or end of life.
• Assist the member with understanding their CCA Health Benefit package.
• Perform annual comprehensive telephonic assessments and coordinate any needed follow up from results.
• Coordinate a host of benefits such as transportation, community resources, interpreter services, hospice services, and more.
• Adhere to appropriate and complete documentation practices, including history of present illness, adjustment, or maintenance of an established treatment plan, and consistent follow up of the plan as evidenced in the documentation.
• Perform episodic urgent medical / behavioral health telephone calls and facilitates such visits are conducted in-person for applicable members on panel to ensure that timely and appropriate medical care in order to avoid emergency department visit or hospitalization.
• Liaise with CCA interdisciplinary site team where applicable and IPA clinical teams to ensure comprehensive member needs are consistently met
• Manage panel-wide and member-specific utilization trends.
• Liaise with CCA and community-based PCPs / specialists
• Collaborate with the Transitions of Care Team on all medical and psychiatric admissions to assist in discharge planning.
• MA / MI only : Reviews approved authorizations to assess appropriate utilization, based on members\' needs
• Actively participate in the evaluation of own performance and progress.
• Participate in activities and education to maintain and advance competency.
• Participate in CCA quality improvement efforts.
• Provide services via telehealth technologies (video, chat, etc.) for clinically appropriate clinical care and care management services.

Working Conditions

• Care Partners work remotely. Must have strong internet signal.
• Must be able to come to the local CCA office and / or provider offices for various meetings as needed
• May require participation in meetings across multiple states via Zoom or telephone.