The Complex Care Manager is responsible for management of medically complex patients supporting the development, implementation, monitoring, and evaluation of complex/chronic care plans. The Complex care Manager directly interfaces with physicians, practices, physician staff and community agencies involved in the care plan.
This position is part of a care management team designed to identify, engage, and enroll appropriate candidates for the complex care management process.
1. Interviews, manages, and evaluates complex care candidates.
2. Develops, implements, monitors, and evaluates ongoing care management plan across care continuum.
3. Participates with the care management team, including team meetings, professional collaboratives, and participation in required meeting with our healthcare partners. (iCMP/TMP)
1. Demonstrates a positive attitude in dealing with patients, co-workers, and other health care providers and ability to address problems and/or crisis situations.
2. Requires the ability to work independently as well as function effectively within a team-based model of care.
3. Able to establish collegial relationships with physicians, office staff and health care providers in physician’s offices, community agencies, hospitals, and other health care facilities.
4. Functioning within the patient centered model of care, demonstrates a commitment to meeting the patient’s needs and expectations.
5. Functioning within the team-based model of care, demonstrates a commitment and accountability to the care management team.
6. Demonstrates initiative and creativity to continuously improve services, work processes, and other activities that affect quality and utilization.
7. Is aware of and follows applicable policies and procedures.
8. Performs all duties as assigned.
Other duties and Responsibilities:
1. Assumes accountability for professional growth and development.
2. Identifies quality of care issues and reports the concerns to the appropriate person.
3. Collects, prepares, and reports data as directed.
1. A registered nurse licensed to practice in Massachusetts with BS, preferred.
2. Certification in Care management (CCM) or other applicable professional certification, preferred
3. Minimum of 5 years’ experience in hospital, health plan, doctor practice or community care management.
4. Previous experience working in ambulatory setting is preferred.
5. Ability to travel to practices, hospital, or administrative offices.
1. Excellent organizational skills.
2. Excellent oral, written, and telephonic skills.
3. Critical thinking and problem-solving ability
4. Demonstrated competency working with health care setting computer systems.
5. Demonstrated competency working with Microsoft Office, Excel, Word, and Powerpoint.
6. Ability to work effectively with physicians and their staff in a physician practice setting.
7. Ability to handle routine work, unexpected priorities, and multi-task.
8. Requires autonomy in decision making using sound judgment based upon factual information, clinical experience, and nursing process.