Role Overview: The RN Field Clinical Care Coordinator is responsible for assessing members’ medical, behavioral, functional, cultural, and socioeconomic needs through face-to-face and telephonic engagements.
They develop and manage individualized care plans, coordinate referrals to social services, and serve as a single point of contact throughout the care continuum.
The role involves collaborating with internal teams, providers, and community resources to ensure timely, quality care delivery.
It requires flexibility to work in the field, visiting members primarily in their homes, and maintaining patient-centered communication.
Qualifications & Skills: Candidates must hold an active RN license in MA, with at least 2 years of clinical experience.
Proficiency in MS Office, reliable internet, and access to a private workspace are essential.
Must have dependable transportation, a valid driver’s license, and ability to travel locally.
Preferred qualifications include a Bachelor’s or Master’s in Nursing, CCM certification, community case management experience, bilingual skills, and familiarity with electronic medical records.
Key Duties:
- Conduct comprehensive needs assessments in person and via phone
- Develop and implement individualized care strategies
- Identify and coordinate social service referrals
- Manage care plans across the care continuum
- Collaborate with care teams, providers, and community partners
- Ensure effective communication to facilitate coordinated care
Additional Information: The role offers competitive pay, benefits, performance rewards, and opportunities for professional development. The position is field-based with some telecommuting flexibility, requiring physical mobility and ability to work in fast-paced environments.