Job Description

Job Description: 023430 Clin Alli-Clin Assessment & CPPosition SummaryCommonwealth 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.Supervision Exercised: NoEssential Duties & ResponsibilitiesConducts 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 immediatelyfollowing 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 PartnerEnsures 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 completionParticipates in assessing and improving quality within the scope of responsibilities and throughout the organizationParticipates in activities and education to maintain and advance clinical competenciesSeeks to maintain a constructive work environment and maintains effective communication with otheremployees and managersMaintains confidentiality of patient and employee informationComplies with organization’s policy and proceduresProvide 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 supervisorWorking ConditionsStandard office conditions.Required EducationAssociate's Degree in NursingRN with active registered nursing license in Commonwealth of Massachusetts, in good standingDesired EducationBachelor's Degree in NursingRequired Experience2+ years experience1+ years of clinical experience in acute/medical surgical settings2+ years experience in home care and/or community settingsCare Management experience strongly preferredDesired ExperienceExperience with electronic medical record strongly preferred (eCW a plus)Knowledge, Skills & Abilities (Required)Proven skills and knowledge base necessary for conducting clinical assessments, clinical decision makingand care deliveryAbility to function independentlyExcellent organizational skillsAbility to function effectively as part of a teamEffective oral and written skillsStrong Interpersonal and customer relation skillsEffective teaching skillsIntermediate to Advanced understanding of Microsoft Office SuiteWilling to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services.Language(s)EnglishBilingual preferredOtherMust be willing and able to travel to member’s homes in addition to working in an office environmentoccasionallyValid driver’s license with no restrictions. Ability to be active and mobile across MassachusettsStandard office equipmentPhysical RequirementsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this jobReasonable accommodations may be made to enable individuals with disabilities to perform the essential functionsWhile performing the duties of this job, the employee is regularly required to stand; use hands to finger, handle, or feel; reach with hands and arms; and talk or hearThe employee is occasionally required to walk; sit; and stoop, kneel, crouch, or crawlThe employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move more than 100 poundsSpecific vision abilities required by this job include close vision, distance vision, and ability to adjust focus

Job Tags

Similar Jobs