Licensed Care Manager, Nursing (Part-Time, Fitchburg, MA)

Community Care Cooperative • Boston, MA

1d • $44 - $53 • Hybrid

About The Position

As an integral member of the care management team, the Licensed Care Manager will have the opportunity to have a profound impact on the lives of people living with complex and/or chronic conditions, many of whom also face multiple barriers in their lives, which make it difficult for them to achieve the self-care required to improve their health and well-being. This position is currently hybrid, but requires flexibility, and may vary from day-to-day to meet members where they are. The Position is hybrid though primarily remote and will cover care management vacancies at C3 affiliated FQHC’s and affiliated provider groups.

Requirements

• 3-5 years of nursing experience, preferably in case/care management, home health, ambulatory care, community public health, coordinating care across multiple settings and with multiple providers
• Demonstrated success in working as part of a multi-disciplinary team including communicating and working with Providers, Pharmacists, Nurses, Community Health Workers, and other health care teams
• Ability to flexibly utilize clinical expertise to solve complex problems
• Experience working with patients with chronic medical and behavioral health needs
• Must be flexible and adaptable to change
• Demonstrate the ability to work independently
• Must demonstrate excellent organizational and interpersonal communication skills
• Ability to balance more than one health center assignment at any given time
• Ability to manage multiple EHRs for clinical documentation
• Current, active MA Registered Nurse license
• A valid driver's license and provision of a working vehicle

Nice To Haves

• Bi-lingual preferred
• Additional qualities that would be a good fit for our team include; Enthusiasm and passion for helping patients, genuine spirit, kind, and empathetic nature, and one who embraces a ‘go with the flow’ mentality
• Experience using appropriate technology, such as computers, for work-based communication
• Experience and proficiency with Microsoft Office and online record keeping
• Experience within the ACOs member population preferred including Medicare/Medicaid
• Experience with Epic preferred
• Experience working with Federally Qualified Health Centers is strongly preferred
• Experience with anti-racism activities, and/or lived experience with racism is highly preferred
• Case Management Certification (CCM, ANCC RN-BC) preferred though not required

Responsibilities

• Conducts Comprehensive Clinical Assessments
• Assures that medication reconciliation is complete depending on MA state licensure. The RN CM will complete the medication reconciliation and may include a pharmacist and/or primary care Team
• Engages members and caregivers in active care planning with a focus on medical, behavioral, social, member-centered care needs. Coaches and guides member/representative to meet bio/psycho/social care goals
• Provide care coordination, which may include but is not limited to facilitating care transitions, supporting the completion of referrals, and/or providing or confirming appropriate follow-up
• May be required to meet members while they are inpatient to provide education and support about the discharge process and transition the member into care management
• Assesses the member’s knowledge of their medical, behavioral health and/or social conditions and provides education and self-management support based on the member’s needs and preferences
• Connects members with primary care, behavioral health, HRSN services, respite, and other community based social services as indicated and appropriate
• In collaboration with Community Health Workers, creates and maintains a comprehensive inventory of local community resources through a web-based application, improving accessibility for members and providers, and linking members with the appropriate support services
• Participates in the integrated care team meetings and rounds as required
• Maintain accurate, timely documentation in electronic systems including health center EHRs
• Provides coverage for team members who are out of office
• Completes credentialing process per health center assignment
• Other duties as assigned

Benefits

• In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law.

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level