Job Information
Commonwealth Care Alliance Assessment Registered Nurse (RN) - Plymouth County in Boston, Massachusetts
Why This Role is Important to Us:
Commonwealth Care Alliance's (CCA) Care Planning Unit (CPU) is primarily responsible for developing and ensuring adherence to high quality, member-centric care plans through timely execution of community-based assessments for CCA members and ongoing tracking and monitoring.
The Care Planner conducts timely, high quality, accurate in-person assessments. This individual leverages the Minimum Data Set (MDS) assessment and develops and documents person-centered care plan using data collected during the assessment process. This individual works collaboratively with other members of the Care Planning Unit and staff in other departments as needed to support timely interventions designed to improve outcomes for CCA members.
The Care Planner reports to the Regional RN Supervisor.
What You'll Be Doing:
Conducts in-person assessment visits. Documents templated summary of visit highlights; documents MDS and develops initial person-centered Care Plan including current Service Plan within 48 hours of visit.
Communicates any time-sensitive concerns to Regional RN Supervisor and/or NP during or immediately
following visit.
Reviews members with NP and BH Specialist staff in weekly Stratification meetings to validate Care Model assignment and facilitate warm hand off to Care Partner
Ensures immediate referral to any time-sensitive services such as Behavioral Health, Long Term Services and Supports or Physical Therapy.
Manages assessment activities through calendar and tracks status of completion
Participates in assessing and improving quality within the scope of responsibilities and throughout the organization
Participates in activities and education to maintain and advance clinical competencies
Seeks to maintain a constructive work environment and maintains effective communication with other
employees and managers
Maintains confidentiality of patient and employee information
Complies with organization's policy and procedures
Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services.
Additional duties as requested by supervisor
What We're Looking For:
Qualifications:
Associate's Degree in Nursing required, Bachelors Degree in Nursing preferred/
RN with active registered nursing license in Commonwealth of Massachusetts, in good standing required.
2+ years experience required
1+ years of clinical experience in acute/medical surgical settings required
2+ years experience in home care and/or community settings required
Care Management experience strongly preferred
Experience with electronic medical record strongly preferred (eCW a plus)
Proven skills and knowledge base necessary for conducting clinical assessments, clinical decision makingand care delivery
Ability to function independently
Excellent organizational skills
Ability to function effectively as part of a team
Effective oral and written skills
Strong Interpersonal and customer relation skills
Effective teaching skills
Intermediate to Advanced understanding of Microsoft Office Suite
Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services.
English required, Bilingual 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.