RN Care Manager — Community-Based Complex Care Leader

Commonwealth Care Alliance, Inc.; Massachusetts; On-site; USD 80,000 - 120,000; Full time

Job summary

CareSource/Commonwealth Care Alliance in Massachusetts seeks an Integrated Care Clinical Manager to oversee complex care management for dually-eligible enrollees. The RN leads the ICT, coordinates with providers and community resources, and manages care plans to improve outcomes.

The role requires in-home and community visits, strong communication, and effective advocacy, with travel across the assigned territory. A Mass RN license and care coordination experience are highly valued.

Qualifications

• AS in nursing required
• RN with ability to serve complex cases
• Experience in care coordination or dual-eligible populations preferred
• Medicaid/Medicare managed care experience preferred
• Community-based training a plus

Responsibilities

• Engage enrollees in homes and community settings to build complex care management relationships.
• Coordinate with healthcare providers and community resources for seamless care transitions.
• Perform timely assessments including Comprehensive Assessment and MDS-HC.
• Develop and implement care plans; provide regular updates.
• Lead the interdisciplinary care team (ICT) to address medical and non-medical needs.
• Oversee enrollees' use of long-term services to help them stay in their preferred location.
• Assist members in accessing housing, transportation, food assistance, and social services.
• Educate members about their benefits under Medicare and Medicaid.
• Promote self-management and preventive care; close gaps in care.
• Follow up after hospitalizations to ensure continuity and prevent readmissions.
• Coordinate with providers to share information and avoid duplication.
• Advocate for enrollees' needs within the healthcare system.
• Monitor member satisfaction and address concerns.
• Report abuse or neglect as a mandated reporter.
• Adhere to NCQA and Care Management standards.
• Perform other duties as requested.

Skills

Care coordination

Interdisciplinary team leadership

Communication skills

Cultural/linguistic sensitivity

Travel to member locations

Assessment and care planning

Problem solving

CRM/record keeping

Education

Associate of Science in Nursing

RN License (Massachusetts)

Tools

Microsoft Office

Job description

CareSource/Commonwealth Care Alliance in Massachusetts seeks an Integrated Care Clinical Manager to oversee complex care management for dually-eligible enrollees. The RN leads the ICT, coordinates with providers and community resources, and manages care plans to improve outcomes.

The role requires in-home and community visits, strong communication, and effective advocacy, with travel across the assigned territory. A Mass RN license and care coordination experience are highly valued.