The Community Care Manager (CCM) is responsible for establishing, implementing, monitoring, and evaluating high quality cost effective care plans for a designated group of patients in an ambulatory based setting. Working in a Patient Centered Medical Home (PCMH) team based care model, the Community Care Manager will be embedded in a NWPHO affiliated primary care practice(s) and will collaborate with the primary care physicians to plan and implement optimal and efficient care plans and approaches to care for a defined population of patients. This position requires a broad knowledge of clinical care, available health services across the continuum of care, insurance benefit design and reimbursement methods, care integration systems and management and experience in acute care or community case management. The CCM should demonstrate prudent nursing judgment, effective problem solving skills, critical thinking, excellent organizational and interpersonal skills, experience with team based care, creativity, flexibility, and the ability to multi-task. The CCM continually updates and educates him/herself in matters relating to care coordination, applicable Federal and State regulations, risk management, community resources and other pertinent topics.
Graduate of an accredited school of nursing, BSN preferred.
A registered nurse licensed to practice in Massachusetts
Certification in case management (CCM) or other applicable professional certification.
Minimum of 5 years experience in hospital, health plan or community case management or utilization management role.
Previous experience working in a post acute setting such as LTAC, acute rehabilitation, skilled nursing facility, or homecare helpful.
Previous experience working in an ambulatory setting such as a health center or physician’s practice is strongly preferred.
Managed care or previous health care reimbursement knowledge preferred.
Knowledge of nationally accepted utilization review criteria such as Interqual and/or Milliman helpful.
Evidence of continued education and professional development.
Knowledge of the development needs and behaviors of infant, child, adolescent,
adult and older adult patients preferred.
40 hours / day shift.
Newton-Wellesley Hospital - 13 months ago