The Community Nurse Case Manager collaborates with a group of Physicians to pursue cost-effective, quality focused management interventions by achieving a predetermined financial and clinical outcome. Responsible for providing ongoing communication with Medicaid patients, continuing care coordinators, social workers, and physicians to ensure Medicaid patients have appropriate resources/support in the community and intervening when patients are unable to be managed adequately. Tracks Medicaid patients along continuum of care, identifying patterns that have a negative cost-quality impact and assists with the development of plans for improving care.
Registered Nurse with Bachelors Degree in Nursing or equivalent, with current RI license. Minimum of 5 years related clinical experience, demonstrating recent knowledge of case management, utilization review, quality assurance, discharge planning, third party payor regulations and community health.
Experience must demonstrate high level of interpersonal skills, both oral and written, analytical skills, leadership abilities and effectiveness within a team environment. Ability to speak a second language, Spanish preferred. Experience working with the Medicaid population preferred.
Care New England Health System