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

Commonwealth Care Alliance seeks a Care Partner responsible for comprehensive care coordination for members. This includes managing chronic diseases, providing telehealth services, and collaborating with interdisciplinary teams to ensure quality care. The role emphasizes flexibility, enabling remote work with occasional in-person meetings as required.

Qualifications

• Experience in healthcare roles offering care management and coordination.
• Understanding of preventative and primary care protocols.
• Competence in managing chronic illnesses and telehealth practices.

Responsibilities

• Facilitate preventative and primary care following protocols.
• Conduct telephonic assessments and coordinate care.
• Collaborate with interdisciplinary teams and maintain accurate documentation.

Skills

Chronic disease management

Care coordination

Telehealth services

Documentation

Interdisciplinary collaboration

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 enrolled in one or more CCA benefit programs.

The Care Partner serves as the primary clinical and care management provider for a defined panel of CCA members. Responsibilities include comprehensive care management, chronic disease management, preventative care and wellness, coordination with other providers regarding behavioral health and long-term services, and support for end-of-life/palliative care as needed. This role also involves developing and implementing individualized care plans, overseeing and authorizing appropriate services and supplies, with supervision exercised: None.

What You'll Be Doing

• Facilitate preventative and primary care for members, following CCA protocols, medical guidelines, and scope of practice.
• Conduct scheduled telephonic support for chronic disease or end-of-life management.
• Assist members in understanding their CCA health benefits.
• Perform annual telephonic assessments and coordinate follow-up care.
• Coordinate benefits such as transportation, community resources, interpreter services, and hospice.
• Maintain complete and accurate documentation, including medical history, treatment plans, and follow-ups.
• Handle episodic urgent medical/behavioral health calls and facilitate in-person visits when necessary to prevent emergency visits or hospitalizations.
• Collaborate with interdisciplinary teams and community providers to meet member needs.
• Manage utilization trends at both panel-wide and individual levels.
• Coordinate with PCPs and specialists within CCA and the community.
• Work with the Transitions of Care Team on admissions and discharge planning.
• For MA/MI roles: Review authorizations to ensure appropriate utilization based on member needs.
• Participate in self-evaluation, ongoing competency activities, and quality improvement initiatives.
• Provide telehealth services (video, chat, etc.) as appropriate for clinical care and management.

Working Conditions

• Care Partners work remotely with a reliable internet connection.
• Occasional in-person meetings at local CCA or provider offices may be required.
• Participation in multi-state meetings via Zoom or phone may be necessary.