Primary Care Care Management Nurse

Why This Role is Important to Us :

Our team of exceptional professionals provide skilled nursing care, care management and coordination of the plan of care for a specified population of patients in need of intensive care management.

Supervision Exercised : No

What You'll Be Doing :

Our team of exceptional professionals provide skilled nursing care, care management and coordination of the plan of care for a specified population of patients in need of intensive care management.

Continuously assesses member's status with the goal of identifying risk early and intervening as needed to help maintain independence and well-being.

Utilizes assessment and screening data from all members of the interdisciplinary team, the Primary Care Nurse is accountable to create and coordinate the patient centered interdisciplinary care plan.

Ongoing monitoring of preventative health maintenance data on each member, communicating gaps to NP / PA / PCP as needed

For members unable to access the PCP's office, the Care Manager would schedule face-to-face encounters at least monthly and as needed with any change in condition according to the member's care goals.

Authorizes and makes service decisions based on member's care

Works with PCTs to help create individualized, member centric care plans that help support functioning at their highest level of independence and wellbeing.

Promotes member empowerment, principles of self-efficacy and

Adhere to the Code of Conduct

Have a commitment to observing, reporting, and enhancing patient and employee safety as part of an overall emphasis on continuous improvement, learning, and member experience in the organization.

Working Conditions : Standard office conditions

What We're Looking For :

Education Required :

Associate degree or equivalent experience

Education Desired :

Bachelor's Degree

Licensing Required :

Registered Nurse with current MI license in good standing

Experience Required :

3 to 5 years

Minimum of 2 years of clinical experience in acute care / medical surgical settings or community-based practice

Significant experience in home care and / or community settings.

Knowledge, Skills & Abilities Required :

Able to function independently and seek assistance with unusual

Excellent organizational

Ability to function effectively as part of a

Strong interpersonal and customer relations

Effective teaching

Proficient in Microsoft Office Products

Knowledge, Skills & Abilities Desired :

Usage of E- Clinical works preferred

Discharge planning and case management experience desired.

Language(s) Required :

Fluency in English

Language(s) Desired :

One or more of the following languages preferred : Spanish, Portuguese, Russian, Nepalese, and Vietnamese. Bi-cultural preferred.

EEO is The Law

Equal Opportunity Employer Minorities / Women / Protected Veterans / Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA / RN license (if applicable).

Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.