RN Care Manager: Complex Dual-Eligible Care

CareSource; Massachusetts; Hybrid; USD 80,000 - 120,000; Full time

Job summary

CareSource Commonwealth Care Alliance in Massachusetts is seeking an Integrated Care Clinical Manager (RN) to oversee complex care management for dually-eligible enrollees. The role focuses on coordinating health services and community resources and leading the interdisciplinary care team to ensure seamless care transitions.

The position requires an RN with strong communication and organizational skills, experience in care coordination, and a commitment to improving health outcomes and quality

Qualifications

• Associates of Science degree in nursing from an accredited nursing program required.
• A Registered Nurse with the ability to independently serve people with complex medical, behavioral, and social needs required.
• Prior experience in care coordination, case management, or working with dual-eligible populations preferred.
• Medicaid and/or Medicare managed care experience preferred.
• Clinical Field/ Community Based Training a Plus.

Responsibilities

• Engage enrollees in homes and community settings to build a complex care management relationship.
• Liaise between healthcare providers, community resources, and enrollees to coordinate care transitions.
• Perform Comprehensive Assessments, MDS-HC or successor Functional Assessments, and Risk Assessments.
• Lead the interdisciplinary care team (ICT) to create holistic care plans addressing medical and non-medical needs.
• Oversee utilisation of long-term services and supports and ensure access for enrollees to desired locations.
• Educate members about benefits, services, managing chronic conditions, and preventive care.
• Follow up after hospitalizations or significant health events to prevent readmissions.
• Coordinate with providers and community partners to avoid duplication of services.
• Advocate for enrollees within the healthcare system.
• Document satisfaction and monitor concerns as part of quality improvement.

Skills

Interpersonal skills

Communication skills

Multitasking

Decision making

Problem solving

Independent worker

Education

Associate of Science in Nursing

RN license

Case Management Certification

Job description

CareSource Commonwealth Care Alliance in Massachusetts is seeking an Integrated Care Clinical Manager (RN) to oversee complex care management for dually-eligible enrollees. The role focuses on coordinating health services and community resources and leading the interdisciplinary care team to ensure seamless care transitions.

The position requires an RN with strong communication and organizational skills, experience in care coordination, and a commitment to improving health outcomes and quality