Mountain Laurel Recovery Center jobs

011250 CCA-Claims This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time. Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the end-to-end review, analysis, and resolution of complex reimbursement issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit, compliance, and provider engagement initiatives. This role also provides support in managing provider disputes and escalations requiring detailed pricing and reimbursement validation. Supervision Exercised: No, this position does not have direct reports. Essential Duties & Responsibilities: Analyze MassHealth and Medicare claim reimbursements to ensure compliance with contractual terms, state and federal regulations, and internal payment policies. Resolve provider inquiries and disputes related to pricing discrepancies, contract interpretation, and fee schedule issues. Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams to validate and resolve reimbursement concerns. Conduct retrospective audits to identify systemic payment issues and recommend resolution pathways. Interpret and apply MassHealth fee schedules, All-Payer Rate Setting regulations, and CMS payment methodologies (e.g., DRG, APC, RBRVS). Support provider appeal reviews and internal payment integrity investigations by providing reimbursement validation. Escalate systemic or high-impact discrepancies to the Director of Claims Operations and Quality Assurance for further investigation or configuration updates. Document all research, findings, and outcomes in claims systems (e.g., Salesforce, Facets) in compliance with audit standards and MassHealth requirements. Maintain awareness of MassHealth transmittals, billing guides, and program updates to ensure adherence in payment practices. Ensure SLA compliance for inquiry resolution, appeal response times, and post-payment audits. Assist in the resolution of complex provider disputes and escalations, including direct support to leadership in pricing determinations and dispute case documentation. Working Conditions: Standard office conditions. Required Education (must have): N/A Desired Education (nice to have): Associate's or Bachelor's degree in Health Administration, Finance, or related field preferred. Certified Professional Coder (CPC) - AAPC Certified Claims Professional (CCP) Other AHIMA or Medicaid billing-related certifications Required Experience (must have): 3+ years in healthcare claims processing, provider reimbursement, or payment integrity. Experience with core claims platforms such as Facets, QNXT, or Amisys. Desired Experience (nice to have): Prior experience working with MassHealth and Medicare Advantage reimbursement rules is strongly preferred. Required Knowledge, Skills & Abilities (must have): Proficiency with Excel and reporting tools for data analysis. Understanding of provider contracts, rate tables, and state-set payment methodologies. Strong problem-solving and analytical skills. Effective verbal and written communication with both internal stakeholders and providers. Meticulous attention to detail and documentation standards. Required Language (must have): English Desired Knowledge, Skills, Abilities & Language (nice to have): Knowledge of Facets, MassHealth, and CMS is a plus. Compensation Range/Target: $64,000 - $96,000 Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

011230 CA-Provider Engagement & Performance Commonwealth Care Alliance's Long-Term Services and Supports (LTSS) team is responsible for relationship management with the contracted community-based organizations (CBOs) that provide service coordination and other supports for CCA members. This includes providing ongoing training and technical assistance on policies and procedures, interfacing with other CCA departments to promote strong working relationships between CCA staff and CBOs and the ongoing evaluation of the appropriateness, efficiency and quality of the services provided. The LTSS Program Specialist will have a wide range of responsibilities including project management support, data review, documentation, and assisting external partners. There will be opportunities to contribute beyond the essential duties and responsibilities listed below based on individual interest and demonstrated capabilities. The position will report to the LTSS Program Manager. Reporting to the Manager, LTSS Program, this position supports the efficient operations and performance of CCA's contracted CBOs by providing project management support and performing specified administrative functions, including, but not limited to: (a) invoice management, (b) member roster management, (c) coordination of onboarding and training of related CBO staff, (d) data review, reporting and analysis, and (e)assistance to these external partners as necessary. The Specialist is expected to work with managers and staff across the organization as well as interface with external community-based partners. There will be opportunities to contribute beyond the essential duties and responsibilities listed below based on individual interest and demonstrated capabilities. Supervision Exercised: - No, this position does not have direct reports. Essential Duties & Responsibilities: - Support LTSS network program operations o Developing agendas, taking, and disseminating notes, documenting action steps, communication, and follow-up with members of group with the oversight of the Manager, LTSS Program o Schedule regular check in meetings/calls with ASAPs and LTSC Agencies - Performance reporting/data management support o Link with CCA's Business Intelligence team and Provider Engagement Analytics Manager to request reports as needed o Perform data quality checks, and additional data review steps o Contribute to the development of reports to share with CBOs to provide information about their operations and performance o Continued development of specifications for reports; work with finance, business intelligence and other CCA teams to develop, implement and update existing reports o Support maintenance of reporting inventory - Roster Reporting and Reconciliation o Partner with CCA's Eligibility Team to obtain and perform data entry on information from ASAPs and LTSC Agencies related to member rosters and enrollment records o Perform data quality checks, and additional data review steps, to ensure data integrity of member record to include accurate ASAP, LTSC Agency, GSSC and LTSC, among other details o Coordinate Provider Rosters with the Provider Data Networks Team - Disseminate information to CBOs o Support Manager in developing guidelines, reference guides, workflows and SOPs, disseminating them to CBOs and answering questions to ensure efficient day to day operations o Draft email communications under supervision of Manager o Maintain materials and design of CCA Extranet/Sharepoint as a key resource for information o Ongoing communication with CBO staff and CCA internal departments through email and phone calls - Onboarding o Manage onboarding process to ensure all trainings and documentation are completed o Connect with appropriate departments across CCA to complete Onboarding process o Manage role transitions and terminations by checking in with appropriate departments across CCA and confirming termination of access to CCA accounts (Reporting, ECW, Extranet, Guiding Care, LMS, and others) o Update Staffing lists on a monthly basis and share with appropriate teams across CCA - Manage Assignment Transfer process and workflow for CBOs related to agency or GSSC and LTSC assignment transfers - Support ad hoc trainings and meetings o Prepare meeting materials, agenda creation, note-taking, and manage other meeting logistics for meeting bringing together all CBOs with key CCA staff to share best practices and lessons learned o Coordinate with CBOs to ensure staff registration and participation o Maintain training agendas, presentations, and attendance sheets o Support LTSS Program Manager in times of audits - Contribute to maintaining relationships with internal departments and partnered organizations as needed to promote the goals of LTSS Program - Track support tickets to ensure resolution - Manage tracking logs for assignment transfers, support tickets, issue escalations, extranet, and communications - Other duties as assigned Working Conditions: - This is a remote or hybrid role with the expectation of working according to Commonwealth Care Alliance's standard operating hours of 8:30am-5pm Monday-Friday. Required Education (must have): - Bachelor's degree Desired Education (nice to have): - Bachelor's degree in public health, health management, social work, or a related field preferred. Required Experience (must have): - 1+ years of experience Desired Experience (nice to have): - Experience with dual-eligible (DSNP) populations preferred. - 1+ years of experience in LTSS, social work, provider relations, healthcare communications, project management, or network management within a health plan or similar environment. Required Knowledge, Skills & Abilities (must have): - Must have ability to learn new systems and databases that CCA implements. - Working knowledge of Medicare and Medicaid (MassHealth) - Familiarity with and full support of independent living, recovery, and person-centered planning philosophy and strategies; - Must be proficient in the use of computers, specifically Microsoft Office suite. - Demonstrated skills in Excel and PowerPoint - Experience or knowledge of community based services for seniors and disabled individuals, including extensive knowledge of the ASAPs. - Polished, professional presentation skills in working with key provider partners and internal leaders. - Exceptional written and verbal communication skills, with the ability to translate complex information for diverse provider and internal audiences. - Excellent organizational, analytical, and problem-solving abilities. - Ability to build and maintain positive relationships and collaborate effectively with internal and external stakeholders. - Proactive in identifying issues and developing effective solutions. - Adaptable and able to thrive in high-pressure environments, adjust to shifting priorities, and manage multiple deadlines. - Results-oriented and self-motivated, with the ability to work independently and as part of a team to meet departmental goals. - Demonstrates empathy, self-awareness, and the ability to navigate sensitive conversations diplomatically. - Must be able to work collaboratively and create an atmosphere of trust and respect within project teams and with external partners - Must be highly organized and self-directed with a proven ability to work with supervision on departmental and cross-functional projects of a diverse nature - Requires excellent interpersonal skills in order to communicate and work with staff and external partners of all skill and experience levels - Strong tactical performer - Demonstrated ability to establish and manage performance and outcome metrics. - Ability to establish and maintain positive and effective work relationships with internal staff, external vendors, and state and federal agencies - Proven skills, knowledge base and judgment necessary for independent decision-making - Excellent organizational, time-management and problem-solving skills - Must be able to exercise a high level of diplomacy to recognize politically sensitive issues - Ability to multi-task and switch gears quickly / effectively Required Language (must have): - English Desired Knowledge, Skills, Abilities & Language (nice to have): - Familiarity with provider network management systems and healthcare data standards. - Project management skills with the demonstrated ability to handle multiple projects. - Strong understanding of Medicare, Medicaid, duals program, and health plan operations, including regulatory and compliance requirements. - Demonstrated knowledge of DMH system and waiver programs helpful. - Demonstrated ability to describe and assess a simple business problem - Demonstrated ability to define a solution to a simple business problem and develop a plan for resolution **Compensation Range/Target: $23.08 - $34.62** Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. 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.

011150 CCA-Network Contracting The LTSS Program Manager is responsible for overseeing relationships and performance with community-based Long-Term Services and Supports (LTSS) provider organizations that serve One Care and Senior Care Options (SCO) members across Massachusetts. This role manages the performance of Commonwealth Care Alliance's (CCA) contracted community-based organizations (CBOs), including Aging Services Access Points (ASAPs) and Long-Term Services Coordinators (LTSC) agencies, ensuring alignment with CCA's model of care and strategic objectives. The Manager fosters effective clinical and programmatic collaboration with provider partners, communicates performance expectations and outcomes, and leads performance evaluation and improvement efforts. Through reporting, data analysis, and partnership management, the LTSS Program Manager ensures that providers meet contractual, regulatory, and quality standards that optimize member outcomes and operational efficiency. This role is accountable for ensuring that external provider relationships are high-performing, well-coordinated, and fully integrated with CCA operations so that members' LTSS needs are met in a manner that supports quality, independence, and cost-effective community-based care. The Manager also ensures providers are educated on CCA policies, processes, and structures to enhance collaboration and service quality. This position offers broad exposure across multiple organizational areas and requires close collaboration with internal leadership, operations teams, and external provider partners. The ideal candidate demonstrates strong organizational, analytical, and relationship-management skills, with the ability to engage diverse stakeholders to identify opportunities and drive both program-wide and provider-specific performance improvement. The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider Engagement team is responsible for building and maintaining relationships with key provider partners to advance CCA's network partnership, quality, and performance objectives. Supervision Exercised: No, this position does not have direct reports. Essential Duties & Responsibilities: Provider Engagement and Relationship Management Serve as the primary liaison for assigned community-based LTSS provider organizations, with a focus on ASAPs, LTSCs, and GSSCs. Build and maintain strong, collaborative relationships with provider partners to promote transparency, accountability, and mutual success. Conduct regular provider meetings (virtual and in-person) to review performance, discuss program updates, and address operational challenges. Represent CCA's LTSS model of care and ensure provider alignment with contractual, operational, and quality expectations. Partner with internal teams to address provider issues and ensure timely resolution. Performance Management Oversee onboarding, training, and ongoing engagement of CCA's LTSS network, including ASAP and LTSC agencies. Lead the monitoring and analysis of provider performance using utilization, quality, and member experience metrics. Collaborate with Business Intelligence, Finance, Quality, and Contracting to develop and disseminate performance reports and dashboards. Develop, implement, and track provider performance improvement plans in partnership with internal and external stakeholders. Ensure compliance with all regulatory and contractual requirements related to LTSS provider reporting and quality standards. Maintain ownership of provider guidance materials, ensuring accuracy and consistency across policies, procedures, and training tools. Support pay-for-performance and value-based contracting programs through data analysis and performance oversight. Program Operations and Development Support the design, implementation, and continuous improvement of LTSS program operations, policies, and workflows related to ASAPs and LTSCs. Collaborate with cross-functional teams to ensure operational alignment and data accuracy, including roster reconciliation, payment processes, and reporting. Manage special projects related to program development, process redesign, and strategic growth. Maintain an organized reporting inventory and ensure consistent and timely dissemination of performance data to providers. Support the development and communication of SOPs, reference guides, and workflows to enhance operational efficiency across LTSS partners. Coordinate updates and maintain LTSS provider materials on CCA's Extranet/SharePoint to ensure accurate and accessible resources. Cross-Functional Collaboration and Continuous Improvement Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management, Utilization Management, and Business Intelligence-to align LTSS performance priorities and initiatives. Support Provider Engagement leadership in advancing enterprise-wide initiatives related to provider partnerships, care coordination, and program integration. Contribute to quality improvement projects, audits, and performance reviews to strengthen LTSS provider engagement and member outcomes. Identify and share best practices to enhance provider collaboration and the overall member experience. Working Conditions: This is a remote or hyrbrid role with the expectation of working according to Commonwealth Care Alliance's standard operating hours of 8:30am-5pm Monday-Friday. Ability to travel to provider offices and access to reliable transportation. Required Education (must have): Bachelor's degree Desired Education (nice to have): Bachelor's degree in public health, health management, social work, or a related field preferred. Required Licensing (must have): Desired Licensing (nice to have): MA Health Enrollment (required if licensed in Massachusetts): No, this is not required for the job. Required Experience (must have): 5+ years Experience with Medicaid and Medicare products and programs Experience or knowledge of community based services for seniors and disabled individuals, including knowledge of ASAPs.and Disability Networks Desired Experience (nice to have): Experience with dual-eligible (SCO or One Care) populations preferred. Experience in healthcare program management, provider relations, or network management Knowledge of Massachusetts LTSS landscape, including ASAPs, GSSCs, LTSCs, and ILCs Required Knowledge, Skills & Abilities (must have): Proven experience in program management and performance monitoring initiatives or relevant position within healthcare or community-based service settings Demonstrated ability to analyze performance, utilization, and quality data, interpret insights, and translate findings into actionable strategies. Proficiency in Microsoft Office Suite (especially Excel and PowerPoint); comfort with data dashboards, reporting tools, and learning new systems and databases. Excellent project management and organizational skills, with the ability to manage multiple priorities, meet deadlines, and coordinate across diverse internal and external stakeholders. Exceptional written and verbal communication skills, with the ability to present complex information clearly and effectively to a wide range of audiences, including senior leadership and external partners. Strong relationship management and collaboration skills, with the ability to build trust, influence others, and work effectively in a matrixed environment. Professional presence, sound judgment, and diplomacy in managing sensitive or high-stakes provider relationships. Excellent organizational, time-management and problem-solving skills Proactive in identifying issues and developing effective solutions. Adaptable and able to thrive in high-pressure environments, adjust to shifting priorities, and manage multiple deadlines. Results-oriented and self-motivated, with the ability to work independently and as part of a team to meet departmental goals. Demonstrates empathy, self-awareness, and the ability to navigate sensitive conversations diplomatically. Must be able to work collaboratively and create an atmosphere of trust and respect within project teams and with external partners Strong tactical performer Must be able to exercise a high level of diplomacy to recognize politically sensitive issues Ability to multi-task and switch gears quickly / effectively Required Language (must have): English Desired Knowledge, Skills, Abilities & Language (nice to have): Familiarity with care management and utilization management systems and workflows for populations with complex medical, behavioral health, and/or social needs. Strong understanding of Medicare, Medicaid (MassHealth), and dual-eligible program operations, including regulatory and compliance requirements. Demonstrated ability to describe and assess a simple business problem Demonstrated ability to define a solution to a simple business problem and develop a plan for resolution Familiarity with and full support of independent living, recovery, and person-centered planning philosophy and strategies; Compensation Range/Target: $99,600 - $149,400 Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

022060 Clin Alli-Hospital to Home The Sr Clinician, Behavioral Health, Hospital to Home provides behavioral health assessments, consultation, education, and support to CCA SCO and One Care clinicians regarding behavioral health/substance abuse treatment and management. The SCBH coordinates behavioral health/addiction treatment services in accordance with the treatment plan, and works collaboratively with the clinical team, ED, and inpatient staff to manage or co-manage complex behavioral health cases. The SCBH will provide crisis management to members in the ED, inpatient unit, and community, along with evaluate members for CCA's Crisis Stabilization Units and evaluate members for other appropriate levels of care. Provide regular support to an engagement center for members. Reports to the Clinical Director. Supervision Exercised: * No, this position does not have direct reports. Essential Duties & Responsibilities: * SCBH will help develop care plans, initial and ongoing member assessment, and education in the ED or inpatient units. * Participates in and lead ongoing behavioral health and substance groups at the Engagement Center * Assess and refer members for CSU level of care or other levels of care. * Communicating with CSU and other community-based services and supports to help members struggling with mental health symptoms. * Ability to connect to resources in the community and refer to these community resources. * Use evidence-based practice to conduct SUD groups along with behavioral health focused groups as needed at Engagement Center. * Facilitates internal and external stakeholder collaboration for successful programing. * Able to provide direct care behavioral health care to members with complex behavioral health needs in the ED, inpatient unit, community or in their home. * Ensures end to end compliance with all regulatory/contractual obligations related to care management in the ED and inpatient unit, in close collaboration with Clinical Vice Presidents/Medical Directors and the Vice President, Regulatory Affairs and Compliance * Able to participates and pass in CPR and Narcan trainings. * Attends external meetings and activities as a representative of the organization as requested * Seeks to maintain a constructive work environment and maintains effective communication with employees and managers * Lead team meetings and social / teambuilding events * Contributes to a continuous learning culture * Participates in orienting and training new employees as required * Documents all clinical work in a timely manner and provides the necessary documentation * Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services. Secondary Duties & Responsibilities * Work with Engagement Center staff to support diversion from ED and provide alternative support options * Collaborate with Care Partners to identify gaps in care/ assessments * Work with Recovery Learning Communities' and Human Service Providers to ensure access to Peers and Recovery coaches individually in the community. * Clinical support for HOW's on site * BH Consultation for Peer Specialist and Recovery Coaches * BH Consultation for Nurses and Medical Staff Working Conditions: * Standard office conditions. * COVID-19 vaccination is required * Must have a valid Driver's License with the Commonwealth of Massachusetts * Standard office equipment * Must have the ability to work in front of a computer and to conduct frequent occasional visits to external sites Required Education (must have): * Master's Degree in Social Work, Counseling, or related field Required Licensing (must have): * License required with the Commonwealth of Massachusetts as a LCSW, LICSW, or LMHC Required Experience (must have): * 1-2 years Desired Experience (nice to have): * Crisis experience preferred, including telephonic. Required Knowledge, Skills & Abilities (must have): * Ability to implement creative solutions to behavioral health problems. * Ability to prioritize workload and manage multiple projects simultaneously as evidenced by demonstrating effective time management skills. * Maintains appropriate written and oral communication, documenting patient encounters, communicating with regulating agencies that may be involved in care, and communicating findings with primary care team * Motivates, empowers, inspires, and collaborates with all members of the organization * Able to work effectively as a part of a team * Effectively understands, communicates, and interacts with people across cultures and social disparities. Aware of one's own cultural worldview and one's attitude towards cultural differences and social justice. Possesses knowledge of different cultural practices and worldviews and exhibits cross-cultural skills. * Demonstrated commitment to and interest in improving health outcomes among marginalized and underserved populations * Excellent organizational, time-management and problem-solving skills * Ability to function effectively as part of a multi-disciplinary team * Curiosity and creativity * Effective oral and written skills * Strong interpersonal skills * Strong attention to detail * Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services. Required Language (must have): * English Compensation Range/Target: $73,600 - $110,400 Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

024040 Clin Alli-HICM 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. Within the CIC Program, the Advanced Practice Clinician (APC - NP or PA) serves as a lead for medical care delivery and care coordination for the most complex medical and behavioral health patients. The APC functions within and is integral in a highly skilled interprofessional team model. The APC ensures that a defined panel of patients receive the highest quality, community-based skilled care within the context of a patient centric individualized plan of care. The APC uses evidence-based care approaches, clinical skills, education, and training to influence the clinical outcomes of assigned patients by impacting acute care utilization, ensuring optimal treatment for chronic disease management, closing of quality gaps, goals of care conversations and advance care planning. Additionally, the APC interfaces closely with the patient's external care team members including PCPs, care providers, specialists, vendor services, among others to maintain collaboration with the patient's entire healthcare team. The APC utilizes all technological modalities and conducts visits within the patient's home, community, and area facilities to ensure connection and to optimize care. The APC will interface with patients during transitional space to promote hospital avoidance and readmission reduction. Additionally, the APC will provide ongoing chronic disease management, urgent visits, promote preventative care and wellness, and provide end of life/palliative care. The APC engages in visits at regularly scheduled intervals to conduct regular assessments to ensure that their patient's Plan of Care is comprehensive and addresses significant medical, behavioral, and social needs. The APC will delegate appropriate visit follow-ups to their interprofessional care team. This position requires in-person visits to patients in their homes and the community across various locations. This position reports to the CIC APC Clinical Manager. Supervision Exercised: No, this position does not have direct reports. Essential Duties & Responsibilities: The primary function of the CIC APC role is delivering care to CCA's most complex patients, providing care management and care coordination support, and collaborating with external providers with the goal of delivering comprehensive care. Essential Duties include - best in class patient care; clear, concise, and effective communication and documentation; and interdisciplinary collaboration with a variety of stakeholders internally and externally. Patient Care: The APC is expected to perform longitudinal routine, and urgent care for an attributed patient panel including (but not limited to): Interface with inpatient or post-acute care team and patient to optimize discharge planning in collaboration with Transitions of Care - (done in-person at facility, telephonically, or virtually) Timely Medical post hospital discharge with focus on hospitalization and utilization reduction Goals of Care conversations, including completion of Health Care Proxy and MOLST forms Long Term Services and Supports (LTSS) assessments and referrals to LTSS providers Medication Reconciliation Proactive and routine well-visits and preventative care Evaluate HEDIS Measure Gaps and work towards closure of gaps in clinical practice and in collaboration with patient's external providers. Evaluate Hierarchical Condition Categories (HCC) and work to recapture Urgent, episodic, or un-well visits Point of care testing and venipuncture Vaccination administration Routine medical follow ups and monitoring - ability to delegate follow ups to appropriate support staff Conduct multiple patient visits within each business day balancing routine, scheduled encounters with episodic or urgent visits to maintain expected productivity Prescribe or bridge prescribe medications based on medical evaluation for acute and chronic conditions independently and in collaboration with PCP and/or external providers. Evaluate for and prescribe necessary Durable Medical Equipment (DME) Monitor response to action or treatment plan with appropriate evaluation and adjustments. Initiate necessary action or treatment changes adhering to CCA Policies and Procedures and within scope of licensure. Leverage emergency medical or psychiatric services as indicated to mitigate Emergency Services and inpatient admissions Documentation/Accountability: Document all visits with focus on clear, comprehensive, and concise charting. Must be able to document in English. Identify, document, and execute a patient-centric plan of care. Ability to communicate and delegate care plans as appropriate utilizing multiple modalities of communication. Completion of all tasks within appropriate timelines as outlined in Scopes of Practice and CCA Guidelines. Comply with organizational policies and procedures. Identify and initialize a plan to resolve areas of opportunity to meet Key Performance Indicators (KPIs). Maintain patient and employee confidentiality. Participate in evaluation of own performance and progress Interdisciplinary Team Collaboration: Serve as a clinical mentor and leader for medical care Proactively and collaboratively work with patients' Primary Care Provider (PCP) and other external providers to ensure a cohesive medical treatment plan is delivered. Conduct on-going and effective collaboration and communication with external providers, including but not limited to Primary Care staff, specialty services, LTSS coordinators, Aging Service Access Points (ASAPs), visiting nurse services, care attendants, patient designated contacts, and next of kin. Conduct on-going and effective collaboration and communication with interdisciplinary team including but not limited to, Health Plan Care Team members, Community Licensed Practical Nurses, Community Health Workers, Community Behavioral Health Clinicians, Medical Directors, Palliative Care Team, Psychiatric services team, Rehab Team, Crisis Response workers, patient Services representatives, administrative staff, and CCA Leaders. Identify and lead ad hoc case reviews with internal/external care team as needed. Participate in committees and workgroups that promote clinical excellence and help to advance CCA's mission and business objectives Participates in CCA quality improvement efforts Assists CCA management and leadership with the development, refinement and enhancement of clinical programs, initiatives, processes, policies, workflows, and projects Other duties as assigned. Working Conditions: 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 Other: Physical requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions While 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 hear The employee is occasionally required to walk; sit; and stoop, kneel, crouch, or crawl The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move more than 100 pounds Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus Must be able to come to the local CCA office May require meetings across the state Required Education (must have): Master's Degree in Nursing or a degree in Physician Assistant Studies Desired Education (nice to have): Doctor of Nursing Practice Required Licensing (must have): Board Certified Nurse Practitioner or Physician Assistant with licensure in good standing in the state served If works in MA role requires MassHealth Enrollment: Current Controlled Substances License Current DEA Controlled Substances License Current CPR or Basic Life Support (BLS) Certification MA Health Enrollment (required if licensed in Massachusetts): Yes, this is required if the incumbent is licensed in Massachusetts. Required Experience (must have): Must meet one of the following requirements: 2+ years' experience as NP or PA caring for patients with complex medical, behavioral health, and social needs; preferred experience in community setting; OR 1-year experience as NP or PA in primary care or care management AND 3+ years' experience as Registered Nurse or EMT-P in a high touch clinical environment or home care; OR If new NP or PA graduate, must have 5+ years' experience as Registered Nurse or EMT-P in a high touch clinical environment or home care. Desired Experience (nice to have): Experience with electronic medical record strongly preferred (eCW a plus) Experience working with managed care population Experience with Medicaid or Medicare programming and insurance products (i.e. ACO, MCO, PACE, or SCO) Required Knowledge, Skills & Abilities (must have): Proven skills, knowledge base, and judgement necessary for independent clinical decision making in alignment with clinical licensure, ability to problem solve. Sufficient visual/hearing ability, with or without reasonable accommodation, to comprehend written/verbal communication and perform physical exams and assessments of patients Strong and effective communication skills, written, verbal, and via electronic modalities Effective teaching skills Mediation and conflict resolution skills Effective organizational and time management skills Ability to advocate for a complex patient population in a culturally competent manner Required Language (must have): English Desired Knowledge, Skills, Abilities & Language (nice to have): Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services. Demonstrated ability to utilize and toggle through multiple EHR platforms Bilingual or multi-lingual

011230 CA-Provider Engagement & Performance The Senior Provider Relations Specialist is responsible for building, maintaining and strengthening relationships with the Commonwealth Care Alliance's (CCA) diverse provider community - including physician, hospital, behavioral health, community-based, LTSS, and HCBS providers. This individual serves as a key liaison, proactively addressing provider needs, ensuring regulatory compliance, and supporting operational excellence to enhance provider satisfaction and member access to care. Reporting to the Senior , Director of Delegation Partnerships., the Senior Provider Relations Account Manager will: Lead provider servicing activities, including onboarding, orientation presentations, and ongoing education initiatives. Serve as a primary resource for resolving provider inquiries and supporting issue resolution. Collaborate in the implementation of CCA's enterprise-wide provider engagement strategy, focused on delivering a best-in-class provider experience. Utilize strategic planning and data-driven insights to identify opportunities for continuous improvement in provider relations and organizational performance. By fostering strong partnerships and supporting process enhancements, the Senior Provider Relations Account Manager plays a vital role in helping CCA achieve its mission and goals within the provider community. Supervision Exercised: No, this position does not have direct reports. Essential Duties & Responsibilities: Relationship Management Develop strong professional relationships with providers across all specialties -, physician, hospital, behavioral health, community based, and ancillary providers and their staff. Serve as the primary liaison to the provider community, researching, resolving, and escalating complex provider issues as needed. Own provider relationships to drive satisfaction, retention, and operational efficiency. Provider Education and Support: Facilitate and lead communication sessions, educating on CCA's policies, program benefits, billing, referral and authorizations regulatory compliance, and contractual expectations. Conduct orientation and ongoing education (virtual and in-person) for new and existing providers. Identify and address training needs, collaborating with internal education and training teams to develop materials. Operational Excellence: Collaborate with cross-functional teams (e.g., Claims, Credentialing, Clinical Care Management, Member Services, Provider Services, Regulatory Affairs, Marketing) to resolve provider issues and reduce administrative burden. Conduct site visits when necessary and coordinate with credentialing department to ensure the collection of required applications and other credentialing documentation Manage and respond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues Prioritize and organize own work to meet deadlines Work collaboratively with Provider Network Management staff to ensure an adequate and appropriate provider network When necessary, participate in contracting strategy discussions around potential recruitment opportunities Coordinate with other CCA departments, including Clinical Management, Member Services, Claims, Regulatory Affairs, Outreach and Marketing, to resolve provider issues. Attend and participate in department staff meetings Assists in the development of training materials and training of Provider Relations Specialists. Assist with designated provider communication tasks. Special projects as assigned or directed Working Conditions: Standard office conditions. This is a remote or hybrid role with the expectation of working according to Commonwealth Care Alliance's standard operating hours of 8:30am-5pm Monday-Friday. Required Education (must have): Bachelor's Degree or equivalent experience Desired Education (nice to have): Required Licensing (must have): Desired Licensing (nice to have): MA Health Enrollment (required if licensed in Massachusetts): No, this is not required for the job. Required Experience (must have): 5+ years of experience Desired Experience (nice to have): Experience with dual-eligible (DSNP) populations preferred. Required Knowledge, Skills & Abilities (must have): Strong claims experience Mentoring subject matter expert of the team Managed Care experience (preferably Medicare/Medicaid) Experience in health plan provider relations Experience with behavioral health providers preferred Understanding of provider office operations as they relate to health plans Knowledge of billing practices and reimbursement methodologies Excellent verbal, written and presentation skills Outstanding Customer Service Skills Intermediate Microsoft Office competency, including Outlook, Word, Excel & Power Point Ability to interact well with individuals on all levels, and maintain a professional image and attitude Strong analytical, problem solving, and project management skills Detail oriented, with the ability to organize and manage multiple priorities Valid Driver's license and reliable insured automobile required Required Language (must have): English Desired Knowledge, Skills, Abilities & Language (nice to have): Compensation Range/Target: $85,200 - $127,800 Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Veteran & First Responder OP Virtual Therapist | Eagle View Behavioral Health | Bettendorf, Iowa About the Job: Eagle View is expanding their Outpatient Services! They are looking for a Veteran and First Responder Outpatient therapist. -FULLY REMOTE -Must hold Iowa License- LISW or LMHC -Part time- 20 hours per week -Afternoons/evenings-flexible due to business needs -PTO package -Much more Roles and Responsibilities: LICENSES/DESIGNATIONS/CERTIFICATIONS: Requisite state or national licensure for professional therapy providers or eligible for state licensure as a professional therapy provider. CPR and de-escalation and restraint certification required (training available upon hire and offered by facility). First aid may be required based on state or facility. SUPERVISORY REQUIREMENTS: This position is an Individual Contributor. ESSENTIAL FUNCTIONS: Conducts a psychosocial assessment and develops an initial discharge plan. Develops and implements treatment plans for patient based on assessment and coordinates any additional services needed, revising as necessary. Conducts individual, group or family sessions as appropriate for the treatment plan of the patient. Applies psychotherapeutic techniques and interventions in the delivery of services to individuals and families for the purpose of treating such diagnosed emotional and behavioral disorders. Participates in multi-disciplinary treatment planning conferences. Presents appropriate patient information to the treatment team. Recommends effective treatment interventions. Maintains a caseload as assigned. Develops and implements special patient groups or program modules. Timely prepares progress notes and treatment updates in the medical record. Maintains all clinical documentation in accordance with regulatory and accrediting standards. Ensures each assigned patient has a structured and clinically appropriate post hospitalization care plan. Acts as Liaison to referral sources and support of continuation of care. Provides crisis intervention to patients and families in acute distress. Provides introduction and initial coordination of wide range of community resources: financial, housing, legal, social/recreational, occupational, spiritual and support groups. May perform case management, discharge or after care planning as needed. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: Master's Degree in Social Work, Counseling or Psychology required. Requires at least one year of experience as a therapist with all age groups. Clinical interviewing and assessment using the Diagnostic Statistical Manual of Mental Disorders. Ability to effectively assess, plan and implement therapeutic social work services in a multidisciplinary setting. Skill in assessment, considerable knowledge of social work principles and practice, social health and welfare programs and government eligibility for these programs; ability to mobilize and coordinate resources effectively. Why Eagle View Behavioral Health?Eagle View Behavioral Health offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Eagle View Behavioral Health is an EOE. Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.

011230 CA-Provider Engagement & Performance The LTSS Program Manager is responsible for overseeing relationships and performance with community-based Long-Term Services and Supports (LTSS) provider organizations that serve One Care and Senior Care Options (SCO) members across Massachusetts. This role manages the performance of Commonwealth Care Alliance's (CCA) contracted community-based organizations (CBOs), including Aging Services Access Points (ASAPs) and Long-Term Services Coordinators (LTSC) agencies, ensuring alignment with CCA's model of care and strategic objectives. The Manager fosters effective clinical and programmatic collaboration with provider partners, communicates performance expectations and outcomes, and leads performance evaluation and improvement efforts. Through reporting, data analysis, and partnership management, the LTSS Program Manager ensures that providers meet contractual, regulatory, and quality standards that optimize member outcomes and operational efficiency. This role is accountable for ensuring that external provider relationships are high-performing, well-coordinated, and fully integrated with CCA operations so that members' LTSS needs are met in a manner that supports quality, independence, and cost-effective community-based care. The Manager also ensures providers are educated on CCA policies, processes, and structures to enhance collaboration and service quality. This position offers broad exposure across multiple organizational areas and requires close collaboration with internal leadership, operations teams, and external provider partners. The ideal candidate demonstrates strong organizational, analytical, and relationship-management skills, with the ability to engage diverse stakeholders to identify opportunities and drive both program-wide and provider-specific performance improvement. The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider Engagement team is responsible for building and maintaining relationships with key provider partners to advance CCA's network partnership, quality, and performance objectives. Supervision Exercised: No, this position does not have direct reports. Essential Duties & Responsibilities: Provider Engagement and Relationship Management Serve as the primary liaison for assigned community-based LTSS provider organizations, with a focus on ASAPs, LTSCs, and GSSCs. Build and maintain strong, collaborative relationships with provider partners to promote transparency, accountability, and mutual success. Conduct regular provider meetings (virtual and in-person) to review performance, discuss program updates, and address operational challenges. Represent CCA's LTSS model of care and ensure provider alignment with contractual, operational, and quality expectations. Partner with internal teams to address provider issues and ensure timely resolution. Performance Management Oversee onboarding, training, and ongoing engagement of CCA's LTSS network, including ASAP and LTSC agencies. Lead the monitoring and analysis of provider performance using utilization, quality, and member experience metrics. Collaborate with Business Intelligence, Finance, Quality, and Contracting to develop and disseminate performance reports and dashboards. Develop, implement, and track provider performance improvement plans in partnership with internal and external stakeholders. Ensure compliance with all regulatory and contractual requirements related to LTSS provider reporting and quality standards. Maintain ownership of provider guidance materials, ensuring accuracy and consistency across policies, procedures, and training tools. Support pay-for-performance and value-based contracting programs through data analysis and performance oversight. Program Operations and Development Support the design, implementation, and continuous improvement of LTSS program operations, policies, and workflows related to ASAPs and LTSCs. Collaborate with cross-functional teams to ensure operational alignment and data accuracy, including roster reconciliation, payment processes, and reporting. Manage special projects related to program development, process redesign, and strategic growth. Maintain an organized reporting inventory and ensure consistent and timely dissemination of performance data to providers. Support the development and communication of SOPs, reference guides, and workflows to enhance operational efficiency across LTSS partners. Coordinate updates and maintain LTSS provider materials on CCA's Extranet/SharePoint to ensure accurate and accessible resources. Cross-Functional Collaboration and Continuous Improvement Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management, Utilization Management, and Business Intelligence-to align LTSS performance priorities and initiatives. Support Provider Engagement leadership in advancing enterprise-wide initiatives related to provider partnerships, care coordination, and program integration. Contribute to quality improvement projects, audits, and performance reviews to strengthen LTSS provider engagement and member outcomes. Identify and share best practices to enhance provider collaboration and the overall member experience. Working Conditions: This is a remote or hyrbrid role with the expectation of working according to Commonwealth Care Alliance's standard operating hours of 8:30am-5pm Monday-Friday. Ability to travel to provider offices and access to reliable transportation. Required Education (must have): Bachelor's degree Desired Education (nice to have): Bachelor's degree in public health, health management, social work, or a related field preferred. Required Licensing (must have): Desired Licensing (nice to have): MA Health Enrollment (required if licensed in Massachusetts): No, this is not required for the job. Required Experience (must have): 5+ years Experience with Medicaid and Medicare products and programs Experience or knowledge of community based services for seniors and disabled individuals, including knowledge of ASAPs.and Disability Networks Desired Experience (nice to have): Experience with dual-eligible (SCO or One Care) populations preferred. Experience in healthcare program management, provider relations, or network management Knowledge of Massachusetts LTSS landscape, including ASAPs, GSSCs, LTSCs, and ILCs Required Knowledge, Skills & Abilities (must have): Proven experience in program management and performance monitoring initiatives or relevant position within healthcare or community-based service settings Demonstrated ability to analyze performance, utilization, and quality data, interpret insights, and translate findings into actionable strategies. Proficiency in Microsoft Office Suite (especially Excel and PowerPoint); comfort with data dashboards, reporting tools, and learning new systems and databases. Excellent project management and organizational skills, with the ability to manage multiple priorities, meet deadlines, and coordinate across diverse internal and external stakeholders. Exceptional written and verbal communication skills, with the ability to present complex information clearly and effectively to a wide range of audiences, including senior leadership and external partners. Strong relationship management and collaboration skills, with the ability to build trust, influence others, and work effectively in a matrixed environment. Professional presence, sound judgment, and diplomacy in managing sensitive or high-stakes provider relationships. Excellent organizational, time-management and problem-solving skills Proactive in identifying issues and developing effective solutions. Adaptable and able to thrive in high-pressure environments, adjust to shifting priorities, and manage multiple deadlines. Results-oriented and self-motivated, with the ability to work independently and as part of a team to meet departmental goals. Demonstrates empathy, self-awareness, and the ability to navigate sensitive conversations diplomatically. Must be able to work collaboratively and create an atmosphere of trust and respect within project teams and with external partners Strong tactical performer Must be able to exercise a high level of diplomacy to recognize politically sensitive issues Ability to multi-task and switch gears quickly / effectively Required Language (must have): English Desired Knowledge, Skills, Abilities & Language (nice to have): Familiarity with care management and utilization management systems and workflows for populations with complex medical, behavioral health, and/or social needs. Strong understanding of Medicare, Medicaid (MassHealth), and dual-eligible program operations, including regulatory and compliance requirements. Demonstrated ability to describe and assess a simple business problem Demonstrated ability to define a solution to a simple business problem and develop a plan for resolution Familiarity with and full support of independent living, recovery, and person-centered planning philosophy and strategies;

023540 Clin Alli-Palliative Care Commonwealth Care Alliance's (CCA) Care Delivery service lines are responsible for providing care delivery and care management to a specific panel of high risk and complex people. This panel of CCA's patients incorporates the care of individuals with significant medical, behavioral, and social complexities that require intensive care management and care delivery. The Care Delivery Admissions Coordinator reports to the Patient Access Manager and will help maintain Care Delivery programming at levels that the department is staffed for, provide initial outreach to patients to explain services and schedule initial visits for the assigned clinician. The RN in this role will also be reviewing Algorithm Identified Patient Referrals, Health Plan Referrals and Palliative Smart List to review CCA Health Plan members identified with Care Delivery needs in the CCA electronic health records to clinically validate finding and assure that the member is an appropriate referral, is in the home or SNF setting where Care Delivery team members can visit in-person to perform assessments and coordinate the referral to the appropriate Care Delivery team. This role will complement the data-driven outcomes Care Delivery achieves by tracking outcomes, opportunities and developing KPIs to achieve best results through feedback to the vendor and utilizing and developing unique reports for tracking outcomes and progress towards them. Supervision Exercised: • No, this position does not have direct reports. Essential Duties & Responsibilities: • Patient Care Support: • This role requires superb communication skills, the ability to speak with members and their caregivers in a health-literate way as well as with internal and external providers. • Review members identified for Care Delivery in the electronic health records to independently clinically validate findings for program admission. • Communicate to PCP and Health Plan team in a succinct way and tracking for approval needed to proceed with the admission. • Assure that the referred member is in the home or SNF setting where team members can visit in-person to perform assessments. Tracks outcomes and opportunities within different facilities to promote more effective member care. • Perform initial outreach to member or healthcare surrogate to explain program in Care Delivery, obtain verbal consent for initial visit, schedule the same with the member or healthcare surrogate and assign clinician in coordination with clinician's supervisor. • Participate with program leadership to independently track and assimilate conclusions around gaps in population health needs for the members served. Identifies process improvement opportunities and implements solutions • Will also develop method for tracking data on admissions; outreach attempts and findings related to demographics and report them to leadership. • Will assimilate trends on the populations in areas served, both members who successfully enroll as well as those who don't. • Will identify quality improvement projects specific to population health for admissions and initiate KPIs to improve performance. • Provide clinical care to members via telehealth technologies (video, chat, etc.) for clinically appropriate clinical care and care management services. • Documentation of all interactions and interventions must be completed within established timelines while maintaining productivity standards • Communication and Collaboration: • Conduct on-going and effective collaboration and communication with interdisciplinary team including but not limited to, Health Plan Care Team, Community Advanced Practice Clinicians, Community Licensed Practical Nurses, Community Health Workers, Community Behavioral Health Clinicians, Medical Directors, Palliative Care Team, Psychiatric services team, Rehab Team, Crisis Response workers, Patient Services representatives, administrative staff, and CCA Leaders. • Provides consultation and support to other members of Care Team • Participates in on-going education and training to improve skills • Assists management with the development, refinement and enhancement of clinical programs, initiatives, processes, policies, workflows, and projects. • Participates in committees and workgroups that promote clinical excellence. • Palliative Care: • Requires extensive knowledge about Palliative vs Hospice care criteria, the ability to educate and support partnerships with external and internal customers. • Review Smart List members identified with Palliative need in the CCA electronic health records to independently clinically validate findings for Serious Illness presence and Palliative care needs. This assimilation will need to be communicated to PCP and CP in a succinct way and tracking for approval needed to proceed with the admission. • Will identify any opportunities within the Smart List for improvement to identify members with Palliative need more accurately and work with the vendor to implement changes. • Other projects and requests as made by the Palliative Director • Other duties as assigned Working Conditions: Standard office conditions. • This position may require 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. Other: Equipment Utilized • Standard office equipment • Experience with electronic medical record strongly preferred eCW a plus) Physical Requirements • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. • While 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 hear. • The employee is occasionally required to walk; sit; and stoop, kneel, crouch, or crawl • The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move more than 100 pounds. • Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus. • Must be able to come to the local CCA office • May require meetings across the state

024450 Clin Alli-Care Management Commonwealth Care Alliance's (CCA) Clinical Care Manager is a registered nurse or other independently licensed behavioral health clinician responsible for providing intensive monitoring, follow-up and clinical care management to a panel of health plan members with complex medical, behavioral, and social care needs, including Severe and Persistent Mental illness. As part of the care management dyad, the Clinical Care Manager works directly with assigned CCA members to help them navigate the health care system, gain access to available services, and assist members with finding answers to their questions. The Clinical Care Manager functions as the clinical expert on an interdisciplinary team through close member oversight, routine and post discharge assessments, providing health education, and provider collaboration. Consults, as needed, with other participants of the interdisciplinary care team on members experiencing medical or behavioral health issues. Responsible for supporting the members in achieving their goals for independent living, recovery, and community connections. This position allows for remote work, when possible, but does require in-person visits to members in their homes and community, as needed. **Supervision Exercised:** + No, this position does not have direct reports. **Essential Duties & Responsibilities:** + Complex care management + Care plan development, updates and implementation with members + Member education + Provider communication, including collaboration with DMH and DDS (BH) + Routine member engagement + Quality gap closures, including: + RN Clinical Care Manager + BH Clinical Care Manager + Medication Reconciliation + Follow up after Hospitalization (FUH) + Blood Pressure readings + Initiation and Engagement (IET) + Participate in interdisciplinary care team meetings + Performs applicable standardized assessments, including MDS, Comprehensive, Functional, and Crisis and Risk Assessments + Perform home visits with member for routine assessments, routine clinical needs, and post transitions of care follow up that require in person evaluations + Monitor available data for assigned members to inform proactive outreaches as well as reactive clinically appropriate assessments to ensure comprehensive knowledge of members current needs to inform continuous and meaningful updates to the care and service plan. + Resource and expert for members regarding available benefits and resources to meet their needs. + Clinical resource for other members of the interdisciplinary care team + Additional duties as requested by supervisor **Working Conditions:** + Standard office conditions + Must be able to travel to member's homes or other community environment + Must be able to come to the local CCA office and/or provider offices for various meetings as needed. + Responsible to provide a strong internet connection when working remotely **Member Facing:** ☒ YES: The job has in-person contact (not telephonic/virtual) with CCA members or patients as part of the job duties. **Required Education (must have):** + RN Clinical Care Managers must have: + Associate degree in nursing + Active RN license, in good standing, in state of assignment. + BH Clinical Care Managers must have: + Master's degree in social work or mental health counseling + Must have an active LCSW, LMHC or LICSW license in good standing in the state assigned; may require multiple state licenses based on product **Desired Education (nice to have):** + Bachelor's or Master's degree in nursing preferred + Other related Healthcare Degree + Certified Care Manager (CCM) **Required Licensing (must have):** + RN Clinical Care Managers must have an Active RN license, in good standing, in state of assignment. + BH Clinical Care Managers must have: an active LCSW, LMHC or LICSW license in good standing in the state assigned; may require multiple state licenses based on product **MA Health Enrollment** **(required if licensed in Massachusetts):** + No, this is not required for the job. **Required Experience (must have):** + Meaningful clinical and care management experience, including 3+ years caring for people with complex medical, behavioral and social needs **Desired Experience (nice to have):** + Experience working in a health plan, with Medicare Advantage and/or dually eligible population + Experience with a care management platform (Guiding Care a plus) + Experience with Substance Use Disorders **Required Knowledge, Skills & Abilities (must have):** + Proven skills, knowledge base, and judgement necessary for independent clinical decision making in alignment with clinical licensure. + Excellent critical thinking, organizational, time management and problem solving skills. + Ability to function independently and effectively as part of an interdisciplinary team + Strong and effective communication skills, both written and verbal + Strong interpersonal and customer relations skills + Strong customer service skills + Ability to work in multiple systems, often simultaneously. + Flexibility to adapt to business needs + Motivated team player + High attention to detail and accuracy **Required Language (must have):** + English **Desired Knowledge, Skills, Abilities & Language (nice to have):** + Ability to utilize an Electronic Medical Record or other electronic platforms + Ability to use on-line training platforms + Demonstrated ability to utilize virtual care platforms + Proficiency in Microsoft Office Suite + Bilingual preferred **Compensation Range/Target:** **$72,480 - $108,720** Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. 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.

011230 CA-Provider Engagement & Performance Commonwealth Care Alliance's Long-Term Services and Supports (LTSS) team is responsible for relationship management with the contracted community-based organizations (CBOs) that provide service coordination and other supports for CCA members. This includes providing ongoing training and technical assistance on policies and procedures, interfacing with other CCA departments to promote strong working relationships between CCA staff and CBOs and the ongoing evaluation of the appropriateness, efficiency and quality of the services provided. The LTSS Program Specialist will have a wide range of responsibilities including project management support, data review, documentation, and assisting external partners. There will be opportunities to contribute beyond the essential duties and responsibilities listed below based on individual interest and demonstrated capabilities. The position will report to the LTSS Program Manager. Reporting to the Manager, LTSS Program, this position supports the efficient operations and performance of CCA's contracted CBOs by providing project management support and performing specified administrative functions, including, but not limited to: (a) invoice management, (b) member roster management, (c) coordination of onboarding and training of related CBO staff, (d) data review, reporting and analysis, and (e)assistance to these external partners as necessary. The Specialist is expected to work with managers and staff across the organization as well as interface with external community-based partners. There will be opportunities to contribute beyond the essential duties and responsibilities listed below based on individual interest and demonstrated capabilities. Supervision Exercised: • No, this position does not have direct reports. Essential Duties & Responsibilities: • Support LTSS network program operations o Developing agendas, taking, and disseminating notes, documenting action steps, communication, and follow-up with members of group with the oversight of the Manager, LTSS Program o Schedule regular check in meetings/calls with ASAPs and LTSC Agencies • Performance reporting/data management support o Link with CCA's Business Intelligence team and Provider Engagement Analytics Manager to request reports as needed o Perform data quality checks, and additional data review steps o Contribute to the development of reports to share with CBOs to provide information about their operations and performance o Continued development of specifications for reports; work with finance, business intelligence and other CCA teams to develop, implement and update existing reports o Support maintenance of reporting inventory • Roster Reporting and Reconciliation o Partner with CCA's Eligibility Team to obtain and perform data entry on information from ASAPs and LTSC Agencies related to member rosters and enrollment records o Perform data quality checks, and additional data review steps, to ensure data integrity of member record to include accurate ASAP, LTSC Agency, GSSC and LTSC, among other details o Coordinate Provider Rosters with the Provider Data Networks Team • Disseminate information to CBOs o Support Manager in developing guidelines, reference guides, workflows and SOPs, disseminating them to CBOs and answering questions to ensure efficient day to day operations o Draft email communications under supervision of Manager o Maintain materials and design of CCA Extranet/Sharepoint as a key resource for information o Ongoing communication with CBO staff and CCA internal departments through email and phone calls • Onboarding o Manage onboarding process to ensure all trainings and documentation are completed o Connect with appropriate departments across CCA to complete Onboarding process o Manage role transitions and terminations by checking in with appropriate departments across CCA and confirming termination of access to CCA accounts (Reporting, ECW, Extranet, Guiding Care, LMS, and others) o Update Staffing lists on a monthly basis and share with appropriate teams across CCA • Manage Assignment Transfer process and workflow for CBOs related to agency or GSSC and LTSC assignment transfers • Support ad hoc trainings and meetings o Prepare meeting materials, agenda creation, note-taking, and manage other meeting logistics for meeting bringing together all CBOs with key CCA staff to share best practices and lessons learned o Coordinate with CBOs to ensure staff registration and participation o Maintain training agendas, presentations, and attendance sheets o Support LTSS Program Manager in times of audits • Contribute to maintaining relationships with internal departments and partnered organizations as needed to promote the goals of LTSS Program • Track support tickets to ensure resolution • Manage tracking logs for assignment transfers, support tickets, issue escalations, extranet, and communications • Other duties as assigned Working Conditions: • This is a remote or hybrid role with the expectation of working according to Commonwealth Care Alliance's standard operating hours of 8:30am-5pm Monday-Friday. Required Education (must have): • Bachelor's degree Desired Education (nice to have): • Bachelor's degree in public health, health management, social work, or a related field preferred. Required Experience (must have): • 1+ years of experience Desired Experience (nice to have): • Experience with dual-eligible (DSNP) populations preferred. • 1+ years of experience in LTSS, social work, provider relations, healthcare communications, project management, or network management within a health plan or similar environment. Required Knowledge, Skills & Abilities (must have): • Must have ability to learn new systems and databases that CCA implements. • Working knowledge of Medicare and Medicaid (MassHealth) • Familiarity with and full support of independent living, recovery, and person-centered planning philosophy and strategies; • Must be proficient in the use of computers, specifically Microsoft Office suite. • Demonstrated skills in Excel and PowerPoint • Experience or knowledge of community based services for seniors and disabled individuals, including extensive knowledge of the ASAPs. • Polished, professional presentation skills in working with key provider partners and internal leaders. • Exceptional written and verbal communication skills, with the ability to translate complex information for diverse provider and internal audiences. • Excellent organizational, analytical, and problem-solving abilities. • Ability to build and maintain positive relationships and collaborate effectively with internal and external stakeholders. • Proactive in identifying issues and developing effective solutions. • Adaptable and able to thrive in high-pressure environments, adjust to shifting priorities, and manage multiple deadlines. • Results-oriented and self-motivated, with the ability to work independently and as part of a team to meet departmental goals. • Demonstrates empathy, self-awareness, and the ability to navigate sensitive conversations diplomatically. • Must be able to work collaboratively and create an atmosphere of trust and respect within project teams and with external partners • Must be highly organized and self-directed with a proven ability to work with supervision on departmental and cross-functional projects of a diverse nature • Requires excellent interpersonal skills in order to communicate and work with staff and external partners of all skill and experience levels • Strong tactical performer • Demonstrated ability to establish and manage performance and outcome metrics. • Ability to establish and maintain positive and effective work relationships with internal staff, external vendors, and state and federal agencies • Proven skills, knowledge base and judgment necessary for independent decision-making • Excellent organizational, time-management and problem-solving skills • Must be able to exercise a high level of diplomacy to recognize politically sensitive issues • Ability to multi-task and switch gears quickly / effectively Required Language (must have): • English Desired Knowledge, Skills, Abilities & Language (nice to have): • Familiarity with provider network management systems and healthcare data standards. • Project management skills with the demonstrated ability to handle multiple projects. • Strong understanding of Medicare, Medicaid, duals program, and health plan operations, including regulatory and compliance requirements. • Demonstrated knowledge of DMH system and waiver programs helpful. • Demonstrated ability to describe and assess a simple business problem • Demonstrated ability to define a solution to a simple business problem and develop a plan for resolution Compensation Range/Target: $23.08 - $34.62 Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

022060 Clin Alli-Hospital to Home The Sr Clinician, Behavioral Health, Hospital to Home provides behavioral health assessments, consultation, education, and support to CCA SCO and One Care clinicians regarding behavioral health/substance abuse treatment and management. The SCBH coordinates behavioral health/addiction treatment services in accordance with the treatment plan, and works collaboratively with the clinical team, ED, and inpatient staff to manage or co-manage complex behavioral health cases. The SCBH will provide crisis management to members in the ED, inpatient unit, and community, along with evaluate members for CCA's Crisis Stabilization Units and evaluate members for other appropriate levels of care. Provide regular support to an engagement center for members. Reports to the Clinical Director. Supervision Exercised: • No, this position does not have direct reports. Essential Duties & Responsibilities: • SCBH will help develop care plans, initial and ongoing member assessment, and education in the ED or inpatient units. • Participates in and lead ongoing behavioral health and substance groups at the Engagement Center • Assess and refer members for CSU level of care or other levels of care. • Communicating with CSU and other community-based services and supports to help members struggling with mental health symptoms. • Ability to connect to resources in the community and refer to these community resources. • Use evidence-based practice to conduct SUD groups along with behavioral health focused groups as needed at Engagement Center. • Facilitates internal and external stakeholder collaboration for successful programing. • Able to provide direct care behavioral health care to members with complex behavioral health needs in the ED, inpatient unit, community or in their home. • Ensures end to end compliance with all regulatory/contractual obligations related to care management in the ED and inpatient unit, in close collaboration with Clinical Vice Presidents/Medical Directors and the Vice President, Regulatory Affairs and Compliance • Able to participates and pass in CPR and Narcan trainings. • Attends external meetings and activities as a representative of the organization as requested • Seeks to maintain a constructive work environment and maintains effective communication with employees and managers • Lead team meetings and social / teambuilding events • Contributes to a continuous learning culture • Participates in orienting and training new employees as required • Documents all clinical work in a timely manner and provides the necessary documentation • Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services. Secondary Duties & Responsibilities • Work with Engagement Center staff to support diversion from ED and provide alternative support options • Collaborate with Care Partners to identify gaps in care/ assessments • Work with Recovery Learning Communities' and Human Service Providers to ensure access to Peers and Recovery coaches individually in the community. • Clinical support for HOW's on site • BH Consultation for Peer Specialist and Recovery Coaches • BH Consultation for Nurses and Medical Staff Working Conditions: • Standard office conditions. • COVID-19 vaccination is required • Must have a valid Driver's License with the Commonwealth of Massachusetts • Standard office equipment • Must have the ability to work in front of a computer and to conduct frequent occasional visits to external sites Required Education (must have): • Master's Degree in Social Work, Counseling, or related field Required Licensing (must have): • License required with the Commonwealth of Massachusetts as a LCSW, LICSW, or LMHC Required Experience (must have): • 1-2 years Desired Experience (nice to have): • Crisis experience preferred, including telephonic. Required Knowledge, Skills & Abilities (must have): • Ability to implement creative solutions to behavioral health problems. • Ability to prioritize workload and manage multiple projects simultaneously as evidenced by demonstrating effective time management skills. • Maintains appropriate written and oral communication, documenting patient encounters, communicating with regulating agencies that may be involved in care, and communicating findings with primary care team • Motivates, empowers, inspires, and collaborates with all members of the organization • Able to work effectively as a part of a team • Effectively understands, communicates, and interacts with people across cultures and social disparities. Aware of one's own cultural worldview and one's attitude towards cultural differences and social justice. Possesses knowledge of different cultural practices and worldviews and exhibits cross-cultural skills. • Demonstrated commitment to and interest in improving health outcomes among marginalized and underserved populations • Excellent organizational, time-management and problem-solving skills • Ability to function effectively as part of a multi-disciplinary team • Curiosity and creativity • Effective oral and written skills • Strong interpersonal skills • Strong attention to detail • Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services. Required Language (must have): • English Compensation Range/Target: $73,600 - $110,400 Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

024040 Clin Alli-HICM 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. Within the CIC Program, the Manager, Clinical APC is responsible for the oversight of clinical care delivery and complex care management within the CIC interdisciplinary team. The Manager, Clinical APC is specifically accountable for assigned Advanced Practice Clinicians and their performance by ensuring specific APC key performance metrics and daily clinical expectations are met. These expectations include oversight of the CIC Program 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. This role will support Eastern or Central Massachusetts. Supervision Exercised: Yes Essential Duties & Responsibilities: Management Responsibilities Manages and mentors APCs on their team with a dotted line for mentorship to interprofessional 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 interprofessional 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. 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 APCs 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 APC 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 through urgent visits, ongoing chronic disease management, and health promotion and preventative approaches Utilizes face to face, in-home, community based, virtual, telephonic, group and case conferencing visit types to enhance patient care and care delivery Engages in regular assessments, visits at regularly scheduled intervals, conducts acute visits as needed, ensures patients Plans of Care is comprehensive and addresses significant medical, behavioral, and social needs Provides short-term “float” capacity to cover absences within the team and to afford flexible responses to needs of the team Maintains close contact and collaboration with the patient's network of providers (PCP and specialists) in the development and implementation of clinical plans of care Performs a discrete set of care management/care coordination functions Working Conditions: Standard office conditions. Valid Driver's License required - up to 20% travel expectation Required Education (must have): Master's Degree in Nursing, or a degree in Physician Assistant Studies Desired Education (nice to have): Master's in Public Health Master's in Education Doctor of Nursing Practice Required Licensing (must have): Board Certified Advanced Practice Clinician Licensure (APRN, PA) with licensure in good standing in the state served Role requires Medicaid Enrollment If works in MA role requires MassHealth Enrollment Candidate will be required to pass CCA's credentialing process. This includes, but is not limited to: Current Controlled Substances License required Current DEA Controlled Substances License required Current CPR or Basic Life Support (BLS) Certification Required Required Experience: Clinical: 3+ years' experience as NP or PA in primary care or care management setting 2+ years caring for patients/members with complex medical, behavioral health, and social needs; preferred experience in community setting Leadership: 2+ years team management/ leadership experience Experience with conflict resolution Desired Experience: Clinical: Tertiary care experience Interdisciplinary Team experience Experience with data-driven evaluation methodologies Program evaluation/ analysis Leadership: Team Development Project Management Required Knowledge, Skills & Abilities: Other Knowledge, Skills & Abilities: Strong interpersonal and communication skills Leadership and organizational skills Proven success in managing cross functional teams Time management and problem-solving skills Electronic medical record fluency Ability to work in a fast-paced environment Proven ability to manage competing priorities Familiarity with MA nursing regulatory scope and guidelines Desired Knowledge, Skills & Abilities: Experience with Medicare and/or Medicaid programming Quality improvement methodologies Process improvement Data Analytics Customer Relationship Management software (CRM) experience Telehealth Credentialing and Enrollment Coding Virtual Care Language(s): Fluent and articulate in written and spoken English Bilingual or multilingual Other Required: Physical requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions While 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 hear The employee is occasionally required to walk; sit; and stoop, kneel, crouch, or crawl The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move more than 100 pounds Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus Must be able to come to the local CCA office May require meetings across the state Other Desired: Program development experience Value-based contracting familiarity Education/Training experience NCQA Accreditation Experience Healthcare Quality Measures

024450 Clin Alli-Care Management Commonwealth Care Alliance's (CCA) Clinical Care Manager is a registered nurse or other independently licensed behavioral health clinician responsible for providing intensive monitoring, follow-up and clinical care management to a panel of health plan members with complex medical, behavioral, and social care needs, including Severe and Persistent Mental illness. As part of the care management dyad, the Clinical Care Manager works directly with assigned CCA members to help them navigate the health care system, gain access to available services, and assist members with finding answers to their questions. The Clinical Care Manager functions as the clinical expert on an interdisciplinary team through close member oversight, routine and post discharge assessments, providing health education, and provider collaboration. Consults, as needed, with other participants of the interdisciplinary care team on members experiencing medical or behavioral health issues. Responsible for supporting the members in achieving their goals for independent living, recovery, and community connections. This position allows for remote work, when possible, but does require in-person visits to members in their homes and community, as needed. **Supervision Exercised:** + No, this position does not have direct reports. **Essential Duties & Responsibilities:** + Complex care management + Care plan development, updates and implementation with members + Member education + Provider communication, including collaboration with DMH and DDS (BH) + Routine member engagement + Quality gap closures, including: + RN Clinical Care Manager + BH Clinical Care Manager + Medication Reconciliation + Follow up after Hospitalization (FUH) + Blood Pressure readings + Initiation and Engagement (IET) + Participate in interdisciplinary care team meetings + Performs applicable standardized assessments, including MDS, Comprehensive, Functional, and Crisis and Risk Assessments + Perform home visits with member for routine assessments, routine clinical needs, and post transitions of care follow up that require in person evaluations + Monitor available data for assigned members to inform proactive outreaches as well as reactive clinically appropriate assessments to ensure comprehensive knowledge of members current needs to inform continuous and meaningful updates to the care and service plan. + Resource and expert for members regarding available benefits and resources to meet their needs. + Clinical resource for other members of the interdisciplinary care team + Additional duties as requested by supervisor **Working Conditions:** + Standard office conditions + Must be able to travel to member's homes or other community environment + Must be able to come to the local CCA office and/or provider offices for various meetings as needed. + Responsible to provide a strong internet connection when working remotely **Member Facing:** ☒ YES: The job has in-person contact (not telephonic/virtual) with CCA members or patients as part of the job duties. **Required Education (must have):** + RN Clinical Care Managers must have: + Associate degree in nursing + Active RN license, in good standing, in state of assignment. + BH Clinical Care Managers must have: + Master's degree in social work or mental health counseling + Must have an active LCSW, LMHC or LICSW license in good standing in the state assigned; may require multiple state licenses based on product **Desired Education (nice to have):** + Bachelor's or Master's degree in nursing preferred + Other related Healthcare Degree + Certified Care Manager (CCM) **Required Licensing (must have):** + RN Clinical Care Managers must have an Active RN license, in good standing, in state of assignment. + BH Clinical Care Managers must have: an active LCSW, LMHC or LICSW license in good standing in the state assigned; may require multiple state licenses based on product **MA Health Enrollment** **(required if licensed in Massachusetts):** + No, this is not required for the job. **Required Experience (must have):** + Meaningful clinical and care management experience, including 3+ years caring for people with complex medical, behavioral and social needs **Desired Experience (nice to have):** + Experience working in a health plan, with Medicare Advantage and/or dually eligible population + Experience with a care management platform (Guiding Care a plus) + Experience with Substance Use Disorders **Required Knowledge, Skills & Abilities (must have):** + Proven skills, knowledge base, and judgement necessary for independent clinical decision making in alignment with clinical licensure. + Excellent critical thinking, organizational, time management and problem solving skills. + Ability to function independently and effectively as part of an interdisciplinary team + Strong and effective communication skills, both written and verbal + Strong interpersonal and customer relations skills + Strong customer service skills + Ability to work in multiple systems, often simultaneously. + Flexibility to adapt to business needs + Motivated team player + High attention to detail and accuracy **Required Language (must have):** + English **Desired Knowledge, Skills, Abilities & Language (nice to have):** + Ability to utilize an Electronic Medical Record or other electronic platforms + Ability to use on-line training platforms + Demonstrated ability to utilize virtual care platforms + Proficiency in Microsoft Office Suite + Bilingual preferred **Compensation Range/Target:** **$72,480 - $108,720** Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. 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.

024040 Clin Alli-HICM Commonwealth Care Alliance's (CCA) Community Intensive Care (CIC) program is responsible for providing care delivery and care management to a specific panel of high risk and complex people. This panel of CCA's patients incorporates the care of individuals with significant medical, behavioral, and social complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary team for medical care delivery and care coordination for the most complex medical and behavioral health patients. The RN participates in providing the highest quality, community-based skilled care to a defined panel of patients within the context of a patient-centric individualized plan of care. As an integral part of an Interprofessional Care Team and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled intervals, and conduct acute visits to ensure that members' Plan of Care is comprehensive and addresses significant medical, behavioral, and social needs. The RN uses evidenced-based care approaches, clinical skills, education, and training to influence the clinical outcomes of assigned patients by impacting acute care utilization, ensuring optimal treatment for chronic disease management, and closing quality gaps. Additionally, the RN interfaces with the patient's external care team members including PCPs, care providers, specialists, and vendor services, among others to maintain collaboration with the patient's entire healthcare team. The RN utilizes all technological modalities and conducts visits within the patient's home, community, and area facilities to ensure connection and optimize care. The RN will interface with patients during transitional space to promote hospital avoidance and readmission reduction. Additionally, the RN will assess the members basic health status, participate in planning and implementing of nursing interventions and care plans, participate in health teaching and health coaching, documentation of findings, and participation in interdisciplinary care planning. The RN will provide direct or indirect nursing care, support of health maintenance by teaching, counseling, collaborative planning, and rehabilitation support. This position requires in-person visits to patients in their homes and communities across various locations. This position reports to the CIC APC Clinical Manager. Supervision Exercised: No, this position does not have direct reports. Essential Duties & Responsibilities: The primary function of the CICRN role is delivering care to CCA's most complex patients, providing care management and care coordination support, and collaborating with external providers with the goal of delivering comprehensive care. Essential Duties Include - best in class patient care; clear, concise, and effective communication and documentation; and interdisciplinary collaboration with a variety of stakeholders internally and externally. Patient Care: Conducts basic health assessments as outlined by RN licensure Provides direct and indirect nursing care within RN scope of practice and with signed provider's order as necessary including conducting medication reconciliations and assessing medication adherence, obtaining vital signs, performing clinical assessment, conducting wound care, perform point of care test, obtaining medication and medical records, functional status assessments, health maintenance education, and health coaching Escalates all pertinent clinical findings to assigned APC within specified timeframes. Performs all activities with closed loop processes. Conducts follow-up telephone calls with patients to ensure satisfaction Assesses quality gap reports at each face-to-face visit; collaborate with care team and PCP to close these gaps Timely Medical post-hospital discharge with focus on hospitalization and utilization reduction. Documents using an Electronic Medical Record, in an effective manner while strictly adhering to CCA policies and procedures. Coordinate with the Care Partner along with the PCP and plus inter-professional care team to identify areas of opportunity, as well as defined resources. Documentation/Accountability: Documents all visits with focus on clear, comprehensive, and concise charting. Must be able to document in English. Completion of all tasks within appropriate timelines as outlines in Scopes of Practice and CCA Guidelines. Comply with organization policies and procedures. Communicates clear loop closure to the interdisciplinary care team and plans for member centric follow-ups as indicated. Identify and initialize a plan to resolve areas of opportunity to meet Key Performance Indicators (KPIs). Maintain patient and employee confidentiality. Actively participates in the evaluation of own performance and progress Provide input to patients care team on key care management/care coordination decisions. Interdisciplinary Team Collaboration: Proactively and collaboratively work with the patient's Primary Care Provider (PCP) and other external providers to ensure a cohesive medical treatment plan is delivered. Conduct on-going and effective collaboration and communication with external providers, including but not limited to Primary Care staff, specialty services, LTSS coordinators, Aging Service Access Points (ASAPs), visiting nurse services, care attendants, patient designated contacts, and next of kin. Conduct on-going and effective collaboration and communication with interdisciplinary team including but not limited to, Health Plan Care Team members, CIC Advanced Practice Clinicians, Community Health Workers, Behavioral Health Clinicians, Medical Directors, Palliative Care Team, Psychiatric services team, Rehab Team, Crisis Response workers, Patient Services representatives, administrative staff, and CCA Leaders. Participates in the interprofessional Care Team meetings. Provides consultation and support to other members of CIC Care Team Participates in on-going education and training to improve skills Assists management with the development, refinement and enhancement of clinical programs, initiatives, processes, policies, workflows, and projects. Participates in committees and workgroups that promote clinical excellence. The CIC RN May also conduct Care Management Activities as assigned including, but not limited to: Conducts a variety of assessments within their scope of practice, including but not limited to the Minimum Data Set (MDS), functional assessment (time for task tool), Comprehensive Assessments, LTSS Assessments, and others as they are assigned. Completes Health Plan assessments at scheduled and timely intervals and off-cycle as indicated Routinely and accurately completes the member-centric Care Plan and provides updates to PCP, Providers, and HP as required Supports the procurement of Durable Medical Equipment, transportation, LTSS services and supports, and community supports as approved Supports escalation of member grievances and appeals Supports the procurement of network providers and assists in closing any gaps in service or care Other duties as assigned. Working Conditions: 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 Other: Standard office equipment Physical Requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions While 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 hear The employee is occasionally required to walk; sit; and stoop, kneel, crouch, or crawl The employee must frequently lift and/or move up to ten pounds and occasionally lift and/or move more than one hundred pounds Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus Required Education (must have): Associate's Degree Desired Education (nice to have): Bachelor's Degree in nursing preferred Required Licensing (must have): Current and active state RN License BLS Certification Required Experience (must have): Meaningful clinical experience in primary care or care management, including: 5+ years' experience as Registered Nurse in a high touch clinical environment or home care AND 2+ years caring for patients/members with complex medical, behavioral health, and social needs Desired Experience (nice to have): 3+ years of minimum experience working in outreach or in the community caring for patients with complex medical, behavioral health, and social needs Experience with electronic medical record strongly preferred (eCW) Experience with disability issues preferred Experience with Medicaid or Medicare programming and insurance products (i.e. ACO, MCO, PACE, or SCO) Required Knowledge, Skills & Abilities (must have): Excellent written and verbal communication skills. Working knowledge of Microsoft Office applications Excellent organizational skills. Ability to utilize an Electronic Medical Record Ability to use on-line training platforms Demonstrated understanding of Mass health benefits Ability to review welcome packets and obtain consent forms Demonstrated understanding of LTSS Proven skills and judgment necessary for independent decision making. Strong organizational, time management and problem-solving skills. Ability to function effectively within a multi-disciplinary team. Effective oral and written skills. Strong interpersonal and customer relations skills. Comfort working with DME vendors, verifying accuracy of products and quotes. Demonstrated proficiency with Microsoft Excel, Word, and Outlook Required Language (must have): English Desired Knowledge, Skills, Abilities & Language (nice to have): Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services. Bilingual or multi-lingual

011230 CA-Provider Engagement & Performance Commonwealth Care Alliance's Long-Term Services and Supports (LTSS) team is responsible for relationship management with the contracted community-based organizations (CBOs) that provide service coordination and other supports for CCA members. This includes providing ongoing training and technical assistance on policies and procedures, interfacing with other CCA departments to promote strong working relationships between CCA staff and CBOs and the ongoing evaluation of the appropriateness, efficiency and quality of the services provided. The LTSS Program Specialist will have a wide range of responsibilities including project management support, data review, documentation, and assisting external partners. There will be opportunities to contribute beyond the essential duties and responsibilities listed below based on individual interest and demonstrated capabilities. The position will report to the LTSS Program Manager. Reporting to the Manager, LTSS Program, this position supports the efficient operations and performance of CCA's contracted CBOs by providing project management support and performing specified administrative functions, including, but not limited to: (a) invoice management, (b) member roster management, (c) coordination of onboarding and training of related CBO staff, (d) data review, reporting and analysis, and (e)assistance to these external partners as necessary. The Specialist is expected to work with managers and staff across the organization as well as interface with external community-based partners. There will be opportunities to contribute beyond the essential duties and responsibilities listed below based on individual interest and demonstrated capabilities. Supervision Exercised: * No, this position does not have direct reports. Essential Duties & Responsibilities: * Support LTSS network program operations o Developing agendas, taking, and disseminating notes, documenting action steps, communication, and follow-up with members of group with the oversight of the Manager, LTSS Program o Schedule regular check in meetings/calls with ASAPs and LTSC Agencies * Performance reporting/data management support o Link with CCA's Business Intelligence team and Provider Engagement Analytics Manager to request reports as needed o Perform data quality checks, and additional data review steps o Contribute to the development of reports to share with CBOs to provide information about their operations and performance o Continued development of specifications for reports; work with finance, business intelligence and other CCA teams to develop, implement and update existing reports o Support maintenance of reporting inventory * Roster Reporting and Reconciliation o Partner with CCA's Eligibility Team to obtain and perform data entry on information from ASAPs and LTSC Agencies related to member rosters and enrollment records o Perform data quality checks, and additional data review steps, to ensure data integrity of member record to include accurate ASAP, LTSC Agency, GSSC and LTSC, among other details o Coordinate Provider Rosters with the Provider Data Networks Team * Disseminate information to CBOs o Support Manager in developing guidelines, reference guides, workflows and SOPs, disseminating them to CBOs and answering questions to ensure efficient day to day operations o Draft email communications under supervision of Manager o Maintain materials and design of CCA Extranet/Sharepoint as a key resource for information o Ongoing communication with CBO staff and CCA internal departments through email and phone calls * Onboarding o Manage onboarding process to ensure all trainings and documentation are completed o Connect with appropriate departments across CCA to complete Onboarding process o Manage role transitions and terminations by checking in with appropriate departments across CCA and confirming termination of access to CCA accounts (Reporting, ECW, Extranet, Guiding Care, LMS, and others) o Update Staffing lists on a monthly basis and share with appropriate teams across CCA * Manage Assignment Transfer process and workflow for CBOs related to agency or GSSC and LTSC assignment transfers * Support ad hoc trainings and meetings o Prepare meeting materials, agenda creation, note-taking, and manage other meeting logistics for meeting bringing together all CBOs with key CCA staff to share best practices and lessons learned o Coordinate with CBOs to ensure staff registration and participation o Maintain training agendas, presentations, and attendance sheets o Support LTSS Program Manager in times of audits * Contribute to maintaining relationships with internal departments and partnered organizations as needed to promote the goals of LTSS Program * Track support tickets to ensure resolution * Manage tracking logs for assignment transfers, support tickets, issue escalations, extranet, and communications * Other duties as assigned Working Conditions: * This is a remote or hybrid role with the expectation of working according to Commonwealth Care Alliance's standard operating hours of 8:30am-5pm Monday-Friday. Required Education (must have): * Bachelor's degree Desired Education (nice to have): * Bachelor's degree in public health, health management, social work, or a related field preferred. Required Experience (must have): * 1+ years of experience Desired Experience (nice to have): * Experience with dual-eligible (DSNP) populations preferred. * 1+ years of experience in LTSS, social work, provider relations, healthcare communications, project management, or network management within a health plan or similar environment. Required Knowledge, Skills & Abilities (must have): * Must have ability to learn new systems and databases that CCA implements. * Working knowledge of Medicare and Medicaid (MassHealth) * Familiarity with and full support of independent living, recovery, and person-centered planning philosophy and strategies; * Must be proficient in the use of computers, specifically Microsoft Office suite. * Demonstrated skills in Excel and PowerPoint * Experience or knowledge of community based services for seniors and disabled individuals, including extensive knowledge of the ASAPs. * Polished, professional presentation skills in working with key provider partners and internal leaders. * Exceptional written and verbal communication skills, with the ability to translate complex information for diverse provider and internal audiences. * Excellent organizational, analytical, and problem-solving abilities. * Ability to build and maintain positive relationships and collaborate effectively with internal and external stakeholders. * Proactive in identifying issues and developing effective solutions. * Adaptable and able to thrive in high-pressure environments, adjust to shifting priorities, and manage multiple deadlines. * Results-oriented and self-motivated, with the ability to work independently and as part of a team to meet departmental goals. * Demonstrates empathy, self-awareness, and the ability to navigate sensitive conversations diplomatically. * Must be able to work collaboratively and create an atmosphere of trust and respect within project teams and with external partners * Must be highly organized and self-directed with a proven ability to work with supervision on departmental and cross-functional projects of a diverse nature * Requires excellent interpersonal skills in order to communicate and work with staff and external partners of all skill and experience levels * Strong tactical performer * Demonstrated ability to establish and manage performance and outcome metrics. * Ability to establish and maintain positive and effective work relationships with internal staff, external vendors, and state and federal agencies * Proven skills, knowledge base and judgment necessary for independent decision-making * Excellent organizational, time-management and problem-solving skills * Must be able to exercise a high level of diplomacy to recognize politically sensitive issues * Ability to multi-task and switch gears quickly / effectively Required Language (must have): * English Desired Knowledge, Skills, Abilities & Language (nice to have): * Familiarity with provider network management systems and healthcare data standards. * Project management skills with the demonstrated ability to handle multiple projects. * Strong understanding of Medicare, Medicaid, duals program, and health plan operations, including regulatory and compliance requirements. * Demonstrated knowledge of DMH system and waiver programs helpful. * Demonstrated ability to describe and assess a simple business problem * Demonstrated ability to define a solution to a simple business problem and develop a plan for resolution Compensation Range/Target: $23.08 - $34.62 Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

022060 Clin Alli-Hospital to Home The Sr Clinician, Behavioral Health, Hospital to Home provides behavioral health assessments, consultation, education, and support to CCA SCO and One Care clinicians regarding behavioral health/substance abuse treatment and management. The SCBH coordinates behavioral health/addiction treatment services in accordance with the treatment plan, and works collaboratively with the clinical team, ED, and inpatient staff to manage or co-manage complex behavioral health cases. The SCBH will provide crisis management to members in the ED, inpatient unit, and community, along with evaluate members for CCA's Crisis Stabilization Units and evaluate members for other appropriate levels of care. Provide regular support to an engagement center for members. Reports to the Clinical Director. Supervision Exercised: - No, this position does not have direct reports. Essential Duties & Responsibilities: - SCBH will help develop care plans, initial and ongoing member assessment, and education in the ED or inpatient units. - Participates in and lead ongoing behavioral health and substance groups at the Engagement Center - Assess and refer members for CSU level of care or other levels of care. - Communicating with CSU and other community-based services and supports to help members struggling with mental health symptoms. - Ability to connect to resources in the community and refer to these community resources. - Use evidence-based practice to conduct SUD groups along with behavioral health focused groups as needed at Engagement Center. - Facilitates internal and external stakeholder collaboration for successful programing. - Able to provide direct care behavioral health care to members with complex behavioral health needs in the ED, inpatient unit, community or in their home. - Ensures end to end compliance with all regulatory/contractual obligations related to care management in the ED and inpatient unit, in close collaboration with Clinical Vice Presidents/Medical Directors and the Vice President, Regulatory Affairs and Compliance - Able to participates and pass in CPR and Narcan trainings. - Attends external meetings and activities as a representative of the organization as requested - Seeks to maintain a constructive work environment and maintains effective communication with employees and managers - Lead team meetings and social / teambuilding events - Contributes to a continuous learning culture - Participates in orienting and training new employees as required - Documents all clinical work in a timely manner and provides the necessary documentation - Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services. Secondary Duties & Responsibilities - Work with Engagement Center staff to support diversion from ED and provide alternative support options - Collaborate with Care Partners to identify gaps in care/ assessments - Work with Recovery Learning Communities' and Human Service Providers to ensure access to Peers and Recovery coaches individually in the community. - Clinical support for HOW's on site - BH Consultation for Peer Specialist and Recovery Coaches - BH Consultation for Nurses and Medical Staff Working Conditions: - Standard office conditions. - COVID-19 vaccination is required - Must have a valid Driver's License with the Commonwealth of Massachusetts - Standard office equipment - Must have the ability to work in front of a computer and to conduct frequent occasional visits to external sites Required Education (must have): - Master's Degree in Social Work, Counseling, or related field Required Licensing (must have): - License required with the Commonwealth of Massachusetts as a LCSW, LICSW, or LMHC Required Experience (must have): - 1-2 years Desired Experience (nice to have): - Crisis experience preferred, including telephonic. Required Knowledge, Skills & Abilities (must have): - Ability to implement creative solutions to behavioral health problems. - Ability to prioritize workload and manage multiple projects simultaneously as evidenced by demonstrating effective time management skills. - Maintains appropriate written and oral communication, documenting patient encounters, communicating with regulating agencies that may be involved in care, and communicating findings with primary care team - Motivates, empowers, inspires, and collaborates with all members of the organization - Able to work effectively as a part of a team - Effectively understands, communicates, and interacts with people across cultures and social disparities. Aware of one's own cultural worldview and one's attitude towards cultural differences and social justice. Possesses knowledge of different cultural practices and worldviews and exhibits cross-cultural skills. - Demonstrated commitment to and interest in improving health outcomes among marginalized and underserved populations - Excellent organizational, time-management and problem-solving skills - Ability to function effectively as part of a multi-disciplinary team - Curiosity and creativity - Effective oral and written skills - Strong interpersonal skills - Strong attention to detail - Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services. Required Language (must have): - English **Compensation Range/Target:** **$73,600 - $110,400** Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. 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.

024700 Clin Alli-Comm Behavioral Health Commonwealth Care Alliance's (CCA) Clinical Care Manager is a registered nurse or other independently licensed behavioral health clinician responsible for providing intensive monitoring, follow-up and clinical care management to a panel of health plan members with complex medical, behavioral, and social care needs, including Severe and Persistent Mental illness. As part of the care management dyad, the Clinical Care Manager works directly with assigned CCA members to help them navigate the health care system, gain access to available services, and assist members with finding answers to their questions. The Clinical Care Manager functions as the clinical expert on an interdisciplinary team through close member oversight, routine and post discharge assessments, providing health education, and provider collaboration. Consults, as needed, with other participants of the interdisciplinary care team on members experiencing medical or behavioral health issues. Responsible for supporting the members in achieving their goals for independent living, recovery, and community connections. This position allows for remote work, when possible, but does require in-person visits to members in their homes and community, as needed. **Supervision Exercised:** + No, this position does not have direct reports. **Essential Duties & Responsibilities:** + Complex care management + Care plan development, updates and implementation with members + Member education + Provider communication, including collaboration with DMH and DDS (BH) + Routine member engagement + Quality gap closures, including: + RN Clinical Care Manager + BH Clinical Care Manager + Medication Reconciliation + Follow up after Hospitalization (FUH) + Blood Pressure readings + Initiation and Engagement (IET) + Participate in interdisciplinary care team meetings + Performs applicable standardized assessments, including MDS, Comprehensive, Functional, and Crisis and Risk Assessments + Perform home visits with member for routine assessments, routine clinical needs, and post transitions of care follow up that require in person evaluations + Monitor available data for assigned members to inform proactive outreaches as well as reactive clinically appropriate assessments to ensure comprehensive knowledge of members current needs to inform continuous and meaningful updates to the care and service plan. + Resource and expert for members regarding available benefits and resources to meet their needs. + Clinical resource for other members of the interdisciplinary care team + Additional duties as requested by supervisor **Working Conditions:** + Standard office conditions + Must be able to travel to member's homes or other community environment + Must be able to come to the local CCA office and/or provider offices for various meetings as needed. + Responsible to provide a strong internet connection when working remotely **Member Facing:** ☒ YES: The job has in-person contact (not telephonic/virtual) with CCA members or patients as part of the job duties. **Required Education (must have):** + RN Clinical Care Managers must have: + Associate degree in nursing + Active RN license, in good standing, in state of assignment. + BH Clinical Care Managers must have: + Master's degree in social work or mental health counseling + Must have an active LCSW, LMHC or LICSW license in good standing in the state assigned; may require multiple state licenses based on product **Desired Education (nice to have):** + Bachelor's or Master's degree in nursing preferred + Other related Healthcare Degree + Certified Care Manager (CCM) **Required Licensing (must have):** + RN Clinical Care Managers must have an Active RN license, in good standing, in state of assignment. + BH Clinical Care Managers must have: an active LCSW, LMHC or LICSW license in good standing in the state assigned; may require multiple state licenses based on product **MA Health Enrollment** **(required if licensed in Massachusetts):** + No, this is not required for the job. **Required Experience (must have):** + Meaningful clinical and care management experience, including 3+ years caring for people with complex medical, behavioral and social needs **Desired Experience (nice to have):** + Experience working in a health plan, with Medicare Advantage and/or dually eligible population + Experience with a care management platform (Guiding Care a plus) + Experience with Substance Use Disorders **Required Knowledge, Skills & Abilities (must have):** + Proven skills, knowledge base, and judgement necessary for independent clinical decision making in alignment with clinical licensure. + Excellent critical thinking, organizational, time management and problem solving skills. + Ability to function independently and effectively as part of an interdisciplinary team + Strong and effective communication skills, both written and verbal + Strong interpersonal and customer relations skills + Strong customer service skills + Ability to work in multiple systems, often simultaneously. + Flexibility to adapt to business needs + Motivated team player + High attention to detail and accuracy **Required Language (must have):** + English **Desired Knowledge, Skills, Abilities & Language (nice to have):** + Ability to utilize an Electronic Medical Record or other electronic platforms + Ability to use on-line training platforms + Demonstrated ability to utilize virtual care platforms + Proficiency in Microsoft Office Suite + 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.

024040 Clin Alli-HICM Commonwealth Care Alliance's (CCA) Community Intensive Care (CIC) program is responsible for providing care delivery and care management to a specific panel of high risk and complex people. This panel of CCA's patients incorporates the care of individuals with significant medical, behavioral, and social complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary team for medical care delivery and care coordination for the most complex medical and behavioral health patients. The RN participates in providing the highest quality, community-based skilled care to a defined panel of patients within the context of a patient-centric individualized plan of care. As an integral part of an Interprofessional Care Team and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled intervals, and conduct acute visits to ensure that members' Plan of Care is comprehensive and addresses significant medical, behavioral, and social needs. The RN uses evidenced-based care approaches, clinical skills, education, and training to influence the clinical outcomes of assigned patients by impacting acute care utilization, ensuring optimal treatment for chronic disease management, and closing quality gaps. Additionally, the RN interfaces with the patient's external care team members including PCPs, care providers, specialists, and vendor services, among others to maintain collaboration with the patient's entire healthcare team. The RN utilizes all technological modalities and conducts visits within the patient's home, community, and area facilities to ensure connection and optimize care. The RN will interface with patients during transitional space to promote hospital avoidance and readmission reduction. Additionally, the RN will assess the members basic health status, participate in planning and implementing of nursing interventions and care plans, participate in health teaching and health coaching, documentation of findings, and participation in interdisciplinary care planning. The RN will provide direct or indirect nursing care, support of health maintenance by teaching, counseling, collaborative planning, and rehabilitation support. This position requires in-person visits to patients in their homes and communities across various locations. This position reports to the CIC APC Clinical Manager. **Supervision Exercised:** No, this position does not have direct reports. **Essential Duties & Responsibilities:** The primary function of the CICRN role is delivering care to CCA's most complex patients, providing care management and care coordination support, and collaborating with external providers with the goal of delivering comprehensive care. Essential Duties Include - best in class patient care; clear, concise, and effective communication and documentation; and interdisciplinary collaboration with a variety of stakeholders internally and externally. **Patient Care:** + Conducts basic health assessments as outlined by RN licensure + Provides direct and indirect nursing care within RN scope of practice and with signed provider's order as necessary including conducting medication reconciliations and assessing medication adherence, obtaining vital signs, performing clinical assessment, conducting wound care, perform point of care test, obtaining medication and medical records, functional status assessments, health maintenance education, and health coaching + Escalates all pertinent clinical findings to assigned APC within specified timeframes. + Performs all activities with closed loop processes. + Conducts follow-up telephone calls with patients to ensure satisfaction + Assesses quality gap reports at each face-to-face visit; collaborate with care team and PCP to close these gaps + Timely Medical post-hospital discharge with focus on hospitalization and utilization reduction. + Documents using an Electronic Medical Record, in an effective manner while strictly adhering to CCA policies and procedures. Coordinate with the Care Partner along with the PCP and plus inter-professional care team to identify areas of opportunity, as well as defined resources. **Documentation/Accountability:** + Documents all visits with focus on clear, comprehensive, and concise charting. Must be able to document in English. + Completion of all tasks within appropriate timelines as outlines in Scopes of Practice and CCA Guidelines. + Comply with organization policies and procedures. + Communicates clear loop closure to the interdisciplinary care team and plans for member centric follow-ups as indicated. + Identify and initialize a plan to resolve areas of opportunity to meet Key Performance Indicators (KPIs). + Maintain patient and employee confidentiality. + Actively participates in the evaluation of own performance and progress + Provide input to patients care team on key care management/care coordination decisions. **Interdisciplinary Team Collaboration:** + Proactively and collaboratively work with the patient's Primary Care Provider (PCP) and other external providers to ensure a cohesive medical treatment plan is delivered. + Conduct on-going and effective collaboration and communication with external providers, including but not limited to Primary Care staff, specialty services, LTSS coordinators, Aging Service Access Points (ASAPs), visiting nurse services, care attendants, patient designated contacts, and next of kin. + Conduct on-going and effective collaboration and communication with interdisciplinary team including but not limited to, Health Plan Care Team members, CIC Advanced Practice Clinicians, Community Health Workers, Behavioral Health Clinicians, Medical Directors, Palliative Care Team, Psychiatric services team, Rehab Team, Crisis Response workers, Patient Services representatives, administrative staff, and CCA Leaders. + Participates in the interprofessional Care Team meetings. + Provides consultation and support to other members of CIC Care Team + Participates in on-going education and training to improve skills + Assists management with the development, refinement and enhancement of clinical programs, initiatives, processes, policies, workflows, and projects. + Participates in committees and workgroups that promote clinical excellence. The CIC RN May also conduct **Care Management Activities** as assigned including, but not limited to: + Conducts a variety of assessments within their scope of practice, including but not limited to the Minimum Data Set (MDS), functional assessment (time for task tool), Comprehensive Assessments, LTSS Assessments, and others as they are assigned. + Completes Health Plan assessments at scheduled and timely intervals and off-cycle as indicated + Routinely and accurately completes the member-centric Care Plan and provides updates to PCP, Providers, and HP as required + Supports the procurement of Durable Medical Equipment, transportation, LTSS services and supports, and community supports as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and assists in closing any gaps in service or care + Other duties as assigned. **Working Conditions:** + 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 **Other:** Standard office equipment Physical Requirements: + The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job + Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions + While 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 hear + The employee is occasionally required to walk; sit; and stoop, kneel, crouch, or crawl + The employee must frequently lift and/or move up to ten pounds and occasionally lift and/or move more than one hundred pounds + Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus **Required Education (must have):** + Associate's Degree **Desired Education (nice to have):** + Bachelor's Degree in nursing preferred **Required Licensing (must have):** + Current and active state RN License + BLS Certification **Required Experience (must have):** + Meaningful clinical experience in primary care or care management, including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + 2+ years caring for patients/members with complex medical, behavioral health, and social needs **Desired Experience (nice to have):** + 3+ years of minimum experience working in outreach or in the community caring for patients with complex medical, behavioral health, and social needs + Experience with electronic medical record strongly preferred (eCW) + Experience with disability issues preferred + Experience with Medicaid or Medicare programming and insurance products (i.e. ACO, MCO, PACE, or SCO) **Required Knowledge, Skills & Abilities (must have):** + Excellent written and verbal communication skills. + Working knowledge of Microsoft Office applications + Excellent organizational skills. + Ability to utilize an Electronic Medical Record + Ability to use on-line training platforms + Demonstrated understanding of Mass health benefits + Ability to review welcome packets and obtain consent forms + Demonstrated understanding of LTSS + Proven skills and judgment necessary for independent decision making. + Strong organizational, time management and problem-solving skills. + Ability to function effectively within a multi-disciplinary team. + Effective oral and written skills. Strong interpersonal and customer relations skills. + Comfort working with DME vendors, verifying accuracy of products and quotes. + Demonstrated proficiency with Microsoft Excel, Word, and Outlook **Required Language (must have):** + English **Desired Knowledge, Skills, Abilities & Language (nice to have):** + Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services. + Bilingual or multi-lingual **Compensation Range/Target:** **$72,480 - $108,720** Commonwealth Care Alliance takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. 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.