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Registered Nurse RN Case Manager- Full time

Boston, MA

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Hiring Company

Northeast Healthcare Recruitment

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Position Description

They use a collaborative process of assessment, planning, implementing, coordinating, monitoring, and evaluating options and services required to meet the members health and social needs. They act as a liaison between our Members, their Responsible Parties and/or Power of Attorneys (RP/POAs), Advance Plan Provider/PCP, and Senior Care stakeholders. 

This is an on-site role in Pinehurst MA. This work is mostly in person with some travel. 4 days in the field and one day from home.

§  Contacts Plan members to conduct a comprehensive health assessment of the individual, develop a plan of care, and participate in the facilities interdisciplinary care team meeting.

§  Serves as health coach to educate the member, the family and/or caregiver, about disease status and treatment, plan benefits, community resources, and resource options

§  Collaborates with members of the interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members

§  Routinely follows up with member as scheduled to assess progress towards goals

§  Communicates with the member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals

§  Provide patient-centered intervention; such as making and verifying appointments, performing medication and care compliance initiatives;.

§  Communicates Member health updates from Care Team to RP/POAs.

§  Coordinates with the Care Team for non-urgent health or clinical questions.

§  Works directly with internal departments to solve Member Grievances, Utilization Management, and Billing related issues.

§  Updates Member and RP/POA contact information such as changes of address, email, or phone numbers.

§  Actively supports Account Manager in identifying and securing contracts with "preferred" Providers.

§  Assists Members, RP/POAs, and Partner Communities with locating in-network providers and scheduling/facilitation of appointments.

§  Assists with (on request of member or APP) coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members.

§  Monitors and, if needed, facilitates care team meetings with facility team, member, responsible partie(s) and the APP/clinical team.

§  Ensures documentation of care team meetings and transmits to Plan.

§  Monitors care plan updates, facilitates APP and PCP input into care plan, and distributes care plan as needed to care team members.

§  Monitors midnight reports/community census to help identify member transitions to hospital or other care levels.

Education & Experience

§  Registered nurse license, active and unencumbered state license in the state where job duties are performed is required. BSN preferred.

§  One (1) year of clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.

§  Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.

§  Case management certification preferred.


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