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RN/BH Care Partner

Company: Commonwealth Care Alliance
Location: Springfield
Posted on: November 17, 2021

Job Description:

  • Facilitates preventative and basic primary care to members, as needed, per CCA standard operating procedures, commonly accepted medical guidelines, and appropriate scope of
  • Provides regularly scheduled telephonic calls to support the management of chronic disease or end of life/
  • Assist the member with understanding their CCA Health Benefit package
  • Performs annual comprehensive telephonic assessments and coordinates any needed follow up from results
  • Coordinates a host of benefits such as transportation, LTSS, interpreter services, hospice services, and more.
  • Adheres to appropriate and complete documentation practices, including: history of present illness, adjustment or maintenance of an established treatment plan, and consistent follow up of the plan as evidenced in the
  • Performs episodic urgent medical/ behavioral health telephone calls and facilitates such visits are conducted in-person for applicable members on panel to ensure that timely and appropriate medical care in order to avoid emergency department visit or
  • Liaises with CCA interdisciplinary site team where applicable to ensure comprehensive member needs are consistently met
  • Manages panel-wide and member-specific utilization trends
  • Liaises with CCA and community-based PCPs/specialists
  • Collaborates with the Transitions of Care Team on all medical and psychiatric admissions to assist in discharge planning
  • Reviews approved authorizations to assess appropriate utilization, based on members' needs
  • Actively participates in the evaluation of own performance and progress
  • Participates in activities and education to maintain and advance competency
  • Participates in CCA quality improvement efforts
  • RN: Associate degree or Diploma in Nursing
  • Must have an active RN license in good standing in the state assigned, may require multiple state licenses based on product
  • BH for SCO and ICO only: Master's Degree with one of these licenses in the applicable state: LCSW, LICSW, or LMHC. Preferred: LICSW or LMHC.
  • RN: BSN or related healthcare Degree preferred RN/BH: CCM preferred
  • RN: 2+ years meaningful clinical experience in primary care or care management including telephonic based setting, home health or acute care case management. Past experience caring for patients/members with complex medical, behavioral health, and social needs strongly preferred. BH: LCSW/LICSW/LMHC with 3-5 years 3-5 years Meaningful clinical experience in community case management, EAP, telephonic case management or primary care. Past experience caring for patients/members with complex medical, behavioral health, and social needs strongly preferred.
  • Experience with a Medicare Advantage population preferred.
  • Ability to use SBAR Communication
  • Ability to utilize an Electronic Medical Record or other electronic platforms
  • Ability to use on-line training platforms
  • Demonstrated understanding of CCA's Model of Care
  • Demonstrated understanding of the benefits of CCA
  • Ability to review welcome packets and obtain consent forms and attach them to EMR
  • Ability to complete and update a Care Plan that meets CCA requirements
  • Demonstrated understanding of LTSS
  • Demonstrated understanding of how to use CDSTs when ordering services
  • Ability to create referrals and authorize services within appropriate time frames
  • Ability to complete and lock all required telephone encounters within 48 hours
  • Ability to lead a family/team meeting for the purposes of discharge planning
  • Demonstrated knowledge and ability to use screening/ assessment tools (e.g., Fall risk assessment, mini cog assessment, nutritional assessment, PHQ 2, PHQ 9, BH)
  • Ability to conduct Crisis assessments over the phone and deploy assistance as needed
  • Demonstrated ability of how to locate current guidelines for recommended screening tests and immunizations
  • Demonstrated understanding of Referral to Specialists
  • Demonstrates the ability to utilize virtual care platformsEnglish required,bilingual preferredEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Keywords: Commonwealth Care Alliance, Springfield , RN/BH Care Partner, Healthcare , Springfield, Massachusetts

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