Community Care Cooperative (C3) is a new, 501(c)(3) not-for-profit, Accountable Care Organization (ACO) governed by FQHCs. Our mission is to leverage the collective strengths of Federally Qualified Health Centers (FQHC) to improve the health and wellness of the people we serve.
The Nurse Care Manager will be responsible for performing comprehensive assessments and care planning for health center patients who have been identified for the MassHealth Long Term Services and Supports Community Partner (LTSS CP) Program. The individual in this role will work directly with health center patients and ensure that the patient's medical, behavioral, and social service needs are assessed, and a plan of care is in place. The Nurse Care Manager will be responsible for collaborating closely with the Patient's primary care team and the assigned LTSS CP provider. This position is a centralized resource who will support multiple health centers teams.
Perform comprehensive assessments and care plans for patients assigned to LTSS CP supports.
Collaborate and coordinate with the LTSS CP provider to promote patient engagement
Maintain communication through face-to-face, telephonic, and/or digital contact with the patient's health center care team
Though the case management is primarily telephonic, may also perform face to face outreach with the patient either at the health center or some other community-based location
Understand and adhere to contractual requirements as it relates to the MassHealth community partner program
Develop excellent relationships with LTSS CP providers
Provide insight and recommendations to promote internal and external process improvements
Maintain accurate, timely documentation in electronic systems
Maintain confidentiality of client and employee information
Function as a clinical resource and perform triage for member calls that may come to C3's Member Advocate team
Minimum of a BSN degree or ASN + relevant experience and current Massachusetts RN license
2+ years case management experience
Experienced working with patients who have complex medical, behavioral and social needs
Excellent organizational and time management skills
The proven ability to work independently
Experienced in engaging patients telephonically and/or in community-based settings
Able to prioritize and flexibly manage a variable workload
Excellent oral and written communication skills
Experience and proficiency with Microsoft Office and online record keeping
A valid driver's license and provision of a working vehicle
Job Posted by ApplicantPro
Associated topics: care, hospice, infusion, intensive, mhb, neonatal, psychiatric, registered nurse, surgery, unit
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.