Commonwealth Care Alliance® (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care®, which yields improved quality outcomes and lower costs of care.

Job Summary

instED provides patient-centered, high-quality acute care in place to adults with complex medical needs. The RN, instED Clinical Resource Center, will provide telephonic triage services to a diverse population to ensure referrals are clinically appropriate. In addition, the RN will track lab results and respond to clinical questions related to referrals and services. The instED RN will engage with patients, clinicians, and care partners who call with urgent clinical needs.

Essential Functions

• Deliver safe, compassionate, timely telephonic nurse triage care for adults with complex medical histories.
• Utilize excellent clinical judgment to prioritize referrals based on acuity and other factors, in accordance with instED policies and procedures.
• Identify emergent situations and facilitate referrals to the emergency department when clinically indicated.
• Provide appropriate clinical advice and teaching.
• Review lab results and track all labs ordered to ensure every lab is resulted and patients are notified appropriately, collaborating with instED physicians and nurse practitioners as needed.
• Communicate with patients to provide education and instructions regarding any recommended follow-up care.
• Complete accurate and appropriate documentation in real-time.
• Participate in Quality Assurance activities in to improve care delivery and patient experience.
• Participate in the development and design of the instED Now platform offering feedback and suggestions for improvement.
• Perform any other job related duties as requested.
  
  

Education And Experience

• Bachelor's degree in Nursing required
• One (1) year of experience triaging adults who are acutely ill or injured required
• Five (5) years of relevant experience as a registered nurse required
• Experience in urgent care or emergency department preferred
• Experience delivering care in a patient's home preferred
• Call center/telephonic triage experience preferred
• Quality and process improvement experience preferred
  
  

Competencies, Knowledge and Skills:

• Experience excelling in a fast-paced healthcare delivery environment
• Strong telephonic triage skills demonstrating sound clinical judgment
• Proven ability to adapt quickly to changing workflows while maintaining a positive attitude
• Ability and desire to work effectively with a diverse patient population including, but not limited to race, ethnicity, gender identity, socioeconomic status, disability, veteran status, and/or limited English proficiency
• Ability to clearly communicate verbally with demonstrated success de-escalating callers who are upset, and always providing high-quality customer service
• Willingness to learn best practices in delivering home-based and telehealth care
• Ability to document detailed and clearly understood triage notes utilizing best nursing practices
• Experience working collaboratively as a team-player
• Fluency in Spanish or Portuguese preferred
  
  

Licensure and Certification:

• Current licensure as a Registered Nurse (RN) and ability to obtain active licensure in states instED is operational required
• Must be willing to obtain a Massachusetts Registered Nurse (RN) license immediately upon hire, and other state licenses, as needed required
  
  

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required
  
  

Compensation Range

$72,200.00 - $115,500.00 CareSource 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.

Compensation Type

Hourly

Competencies

• Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
  
  

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.