RN Care Manager: Complex Dual-Eligible Care Navigator

CareSource; Boston (MA); Hybrid; USD 80,000 - 120,000; Full time

Job summary

CareSource/Commonwealth Care Alliance (CCA) seeks an Integrated Care Clinical Manager - Massachusetts. This RN will monitor and manage complex care for dually-eligible enrollees in home and community settings, coordinating with providers and resources to improve health outcomes and quality of life.

The role requires leading an ICT, developing holistic care plans, and guiding members in managing chronic conditions with an emphasis on prevention and self-management.

Qualifications

• AS degree in nursing required.
• RN license required to practice independently.
• Experience in care coordination or with dual-eligible populations preferred.
• Medicaid and/or Medicare managed care experience preferred.
• Clinical Field/Community Based Training a plus.

Responsibilities

• Engage enrollees in their homes and community settings to establish a complex care management relationship.
• Liaise between healthcare providers, community resources, and enrollees to ensure seamless communication and care transitions.
• Perform comprehensive assessments and functional assessments as appropriate.
• Lead the interdisciplinary care team to create holistic care plans addressing medical and non-medical needs.
• Oversee enrollee utilization of long-term services and supports to maintain preferred living locations.
• Coordinate with primary care physicians, specialists, and community organizations to avoid duplication of services.

Skills

Care coordination

Interdisciplinary team

Communication

Case management

Medicare/Medicaid knowledge

MS Office

Education

Associates of Science (A.S) degree in nursing

Job description

CareSource/Commonwealth Care Alliance (CCA) seeks an Integrated Care Clinical Manager - Massachusetts. This RN will monitor and manage complex care for dually-eligible enrollees in home and community settings, coordinating with providers and resources to improve health outcomes and quality of life.

The role requires leading an ICT, developing holistic care plans, and guiding members in managing chronic conditions with an emphasis on prevention and self-management.