Massachusetts Jobs

Why This Role is Important to Us:

Position Summary:

Commonwealth Care Alliance's (CCA) Community Intensive Care (CIC) programing is responsible for providing care delivery and care management to a specific panel of high risk and complex people.  This panel of patients incorporates the care of individuals with significant medical, behavioral, and social complexities that require intensive care management and care delivery.   

Reporting to an APC Manager within our Community Intensive Care Programming, the Supervisor, CIC Clinical Nursing is responsible for the oversight of clinical care delivery and complex care management within the CIC interdisciplinary team structure. The Supervisor, CIC Clinical Nursing is specifically accountable for assigned RNs and LPNs and their performance by ensuring specific RN and LPN key performance metrics and daily clinical expectations are met. These expectations include oversight of the CIC Programs clinical operations for care delivery and care management, patient experience, and interdisciplinary team collaboration.

This role models and develops efficient, highly productive, and effective clinical teams. The role requires skills in data evaluation, implementation of strategic approaches, and application of current healthcare concepts. It leverages strong interpersonal skills across the organization and with external partners.

Supervision Exercised:

• Yes, which includes but is not limited to providing leadership, work direction, and performance feedback to subordinate staff.

What You'll Be Doing:

Essential Duties & Responsibilities:

Staff Management Responsibilities

• Manages and mentors RNs and LPNs on their team with a dotted line for mentorship to team. This can include 1:1 meetings with staff, review of productivity standards, and ensure quality of care standards are met

• Provides specific clinical guidance and coaching for complex situations that require coordination with other clinical and non-clinical staff to ensure patient needs are met

• Models best practices regarding professional teamwork; demonstrates time management skills, workflow efficiency, service decision-making and delivery of high quality patient-centered care

• Responds to reports of clinical concerns by developing mitigation strategies

• Uses decision-making skills to realign resources within the team/site to account for absences or potential staff shortages

• Participates in Quality Improvement and Innovation projects

• Works cross-functionally within the organization to overcome barriers to effective and efficient local workflows

• Assists management and leadership with the development, implementation, refinement and enhancement of clinical programs, initiatives, processes, policies, and workflows

• Conducts chart reviews, technical, logistical and clinical support

• Holds team accountable to meet Key Performance Indicators and proactively identifies areas of opportunity and improvement for individual contributors.

• Participates in collaborative meetings with client partners -- case presentations, clinical and operational meetings and discussion.

• Creates action/development plans for individual contributors and follows through on plans.

• Accountable for quality and financial outcomes, service utilization, targeted case mix and productivity levels of RNs and LPNs

• Participates in the selection, hiring, and onboarding of staff as well as performance appraisal, documentation of constructive feedback performance recognition, and disciplinary action

• Participates in committees and workgroups that promote clinical excellence and help to advance CCAs mission and business objectives

• Adheres to CCA's Policies and Procedures

• Promptly, and in good faith, reports an instances of suspected fraud, waste and abuse; suspected privacy and/or security incidents; or any compliance concerns identified

• Ensures confidentiality of patient and company proprietary information is maintained.

Clinical Responsibilities

• Clinical Managers will have a 20-30% clinical RN/LPN level expectation.

• Ensures that a defined panel of complex individuals receives the highest quality of care, leveraging member centric and individualized approaches within the CIC Model of care

• Provides direct patient care

• Utilizes face to face, in-home, community based, virtual, telephonic, group and case conferencing visit types to enhance patient care and care delivery

• Provides short-term "float" capacity to cover absences within the team and to afford flexible responses to needs of the team

• Performs a discrete set of care management/care coordination functions

• LPN level expectations may include:

• Durable Medical Equipment Procurement

• Home Care Service Provision

• Prior Authorizations

• Patient Care for basic health assessments, direct and indirect nursing care within LPN scope of practice including obtaining vital signs, performing clinical assessment, conducting wound care, perform point of care test, obtaining medication and medical records, assessing medication adherence, functional status assessments, health maintenance education, and health coaching

• Post-Hospital Discharge and Transitions of Care with focus on hospitalization and utilization reduction.

• Triage Line management and support -- direct patient and provider response and intervention on dedicated Care Delivery lines to ensure rapid response to service needs

• RN level expectations may include:

• Patient care for urgent medical/behavioral visits within the RN scope of practice to ensure that patients are given timely and appropriate medical care in order to avoid emergency room or hospitalization.

• Conducts a variety of assessments within their scope of practice

• Facilitates and/or delivers preventative care to members i.e. Flu vaccine

• With a signed Provider's order, can perform Intermittent Skilled Care as necessary (e.g., wound care, phlebotomy, medication management, routine and chronic disease assessment and other skilled needs).

• Completes all required KPI documentation requirements within the medical record

• Care coordination and case management for patients in collaboration with providers

• Post-Hospital Discharge and Transitions of Care with focus on hospitalization and utilization reduction

Working Conditions:

• Standard office conditions.

• Work locations include residential and community sites.

• This position requires in-person visits to patients in their homes and will support patients across various locations.

• This position requires travel to CCA sites and offices per required need for various team meetings.

• Valid driver's license with no restrictions. Ability to be active and mobile across assigned catchment area.

• COVID-19 vaccination is required

• Compliance with all Community Clinician Occupational Health Requirements

What We're Looking For:

Required Education (must have):

• Associate's Degree in Nursing

Desired Education (nice to have):

• Bachelor's Degree in Nursing

Required Licensing (must have):

• RN with licensure in good standing in Massachusetts

Required Experience (must have):

• 7+ Years Experience as a Registered Nurse in a high-touch clinical environment or home care

• 3+ Years experience in primary care or care management

• Experience with change management and implementation

• Excellent verbal and written communication and interpersonal skills

• Experience with cross-functional/inter-professional collaboration

Desired Experience (nice to have):

• Previous management experience leading interdisciplinary teams

Required Knowledge, Skills & Abilities (must have):

• In--depth knowledge of CCA resources, clinical guidelines, systems, and processes

• Ability to teach, mentor, and coach across disciplines

• Ability to quickly shift gears and move in a new direction without clear guidance

• Knowledge of EMR Platforms: EPIC, eCW and/or AthenaNet preferred

• Excelled knowledge of Microsoft Programs (Teams, Outlook, Excel, etc.)

Required Language (must have):

• English

Desired Knowledge, Skills, Abilities & Language (nice to have):

• Spanish strongly preferred

• Familiarity with current healthcare structure, policy, and payment reform models

• Operational experience of quality improvement and implementation work

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.