Registered Nurse (RN) Clinical Care Manager

Engage with the enrollee in their homes and other community settings to establish an effective, complex care management relationship Function as a liaison between healthcare providers, community resources, and enrollees to ensure seamless communication and care transitions Perform required assessments including Comprehensive Assessment, MDS-HC (or successor) Functional Assessments, and Crisis and Risk Assessments Lead the interdisciplinary care team (ICT) and collaborate with peers to create holistic care plans that address medical and non-medical needs Oversee enrollee utilization of long-term services and supports, ensuring appropriate systems are in place for enrollees to remain in the location of their choice Assist members in accessing community resources, including housing, transportation, and social services Educate members about their benefits and available services under both Medicare and Medicaid Promote healthy lifestyle choices and self-management strategies Follow up with members after hospitalizations to ensure continuity of care and prevent readmissions Work closely with primary care physicians and specialists to coordinate care Advocate for the needs and preferences of enrollees within the healthcare system Requirements Associates of Science (A.S) degree in nursing from an accredited nursing program required A Registered Nurse with the ability to independently serve people with complex medical, behavioral, and social needs. Prior experience in care coordination, case management, or working with dual-eligible populations preferred Medicaid and/or Medicare managed care experience preferred Clinical Field/ Community Based Training a Plus Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel. Understanding of Medicare and Medicaid programs Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers Ability to manage multiple cases and priorities while maintaining attention to detail. Adhere to code of ethics that aligns with professional practice. Awareness of and sensitivity to the diverse backgrounds and needs of the populations served Decision making and problem-solving skills. Ability to function independently and effectively as part of an interdisciplinary team Core Competencies Demonstrates expertise in care coordination and case management, particularly for dual-eligible populations, while effectively engaging with enrollees and healthcare providers. Proficient in conducting comprehensive assessments and creating holistic care plans that address both medical and non-medical needs. Highest-signal resume keywords Registered Nurse (RN) Care Coordination Medicaid Experience Medicare Experience Interdisciplinary Team Collaboration ATS Optimization Keywords Hard Skills Comprehensive Assessment MDS-HC Functional Assessment Crisis Assessment Risk Assessment Care Plan Development Clinical Field Training Case Management Community Resource Access Utilization Management Attention to Detail Soft Skills Interpersonal Skills Communication Skills Decision Making Problem Solving Sensitivity to Diverse Backgrounds Certifications & Qualifications Associates of Science (A.S) in Nursing Registered Nurse License Industry Keywords Healthcare Providers Community Resources Long-Term Services and Supports Medicare Medicaid Care Transitions Holistic Care Self-Management Strategies Continuity of Care Dual-Eligible Populations Tools & Technologies Microsoft Office Outlook Word Excel #J-18808-Ljbffr Jobtailor