Hybrid Primary Care Triage Registered Nurse (RN) - Massachusetts ONLY

Commonwealth Care Alliance® (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care®, which yields improved quality outcomes and lower costs of care. Job Summary The Care Delivery Triage RN is responsible for performing telephonic clinical triage and providing health information service and care coordination as a key part of the primary care team, and acts as the primary liaison with Care Partnership and external care team members when communicating clinical and care management needs. Essential Functions Serves as primary telephonic contact person for clinical and care coordination needs, maintaining timely accurate documentation. Evaluates and assesses health care needs utilizing established triage protocols and documented workflows. Escalates issues to APC/physician based on triage protocol disposition, documented workflows, or nursing judgment. Coordinates and schedules appointments based on triage disposition or as requested by the care team. Provides telephonic education to patient and family regarding chronic disease management and follow-up preventive health maintenance. Serves as primary point of contact with Care Partnership in coordinating health plan activities and care management needs. Participates in the coordination of referrals, specialty visits, testing, social services, and skilled services. Communicates and follows up with skilled services on new/routine orders and chronic disease management. Assists administrative staff in identifying VNA vendors when needed. Performs telephonic follow-up of inpatient and ED care. Attends and participates in team meetings as directed. Utilizes nursing judgement and/or provider order in order to refer to internal and external auxiliary resources such as CCA clinical group CHW, Rehab, Nursing and APCs, home based lab services, instEd, pharmacies, etc. Takes a primary role in coordinating gap closure activities. Communicates lab results and other medical advice with direction from the APC or physician. Assists with logistical planning for vaccination efforts or other clinical initiatives. Assists the APC/physician with submitting lab orders and follow-up as delegated. May be cross-trained to provide backup support to other areas of nursing within practice, including but not limited to clinic‑based care and field support. Perform any other job related duties as requested. Education and Experience Associates degree in nursing required Bachelor's degree in nursing preferred Three (3) years of experience as Registered Nurse in a high touch clinical environment or home care required or Two (2) years of experience caring for patients/members with complex medical, behavioral health, and social needs required Competencies, Knowledge and Skills Strong computer skills Strong clinical assessment skills Strong communication skills Ability to work independently and within a team environment Attention to Detail Critical listening and thinking skills Decision making/problem solving skills Proper phone etiquette Customer service oriented Broad base of clinical knowledge Teaching skills Ability to remain calm under pressure and in member life‑threatening situations Ability to apply multiple communicative skills while utilizing available tools and resources simultaneously Ability to effectively work with patients with various cognitive, physical, and behavioral abilities Ability to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services Licensure and Certification Current, unrestricted RN licensure in Massachusetts required To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process. Working Conditions General office environment; may be required to sit or stand for extended periods of time Up to 15% (occasional) travel may be required to travel to different locations, including homes, offices, or other public settings, to perform work duties Compensation Range $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well‑being and offer a substantial and comprehensive total rewards package. Compensation Type Salary Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #J-18808-Ljbffr