RN Clinical Care Manager - Somerville

caresource; Somerville (MA); On-site; USD 90,000 - 125,000; Full time

Job summary

caresource is seeking an Integrated Care Clinical Manager in Massachusetts to lead in-home and community-based care management for dually-eligible enrollees with complex medical and social needs.

The role coordinates with primary care, specialists, and community resources to develop holistic care plans and improve health outcomes, while guiding a multidisciplinary team and ensuring smooth transitions of care.

Qualifications

• Associates of Science in nursing is required.
• Current RN license in Massachusetts is required.
• Experience in care coordination or dual-eligible populations is preferred.
• Medicare/Medicaid managed care experience is preferred.
• Clinical field/community-based training is a plus.

Responsibilities

• Engage enrollees in their homes and communities to establish complex care management relationships.
• Coordinate with healthcare providers and community resources for seamless care transitions.
• Conduct Comprehensive Assessments and functional assessments as appropriate.
• Lead the interdisciplinary care team to develop holistic care plans.
• Oversee enrollment in long-term services to support staying in the place of choice.
• Educate enrollees about benefits, services, and chronic disease management.
• Follow up after hospitalizations to ensure continuity of care.
• Coordinate with providers and state agencies to avoid duplication of services.

Skills

Interpersonal skills

Communication skills

Case management

Multitasking

Microsoft Office

Travel willingness

Education

A.S. in Nursing

Massachusetts RN license

Tools

MS Office

Job description

Job Summary:

The Integrated Care Clinical Manager - Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on integrating health services and community resources to coordinate enrollee care for improve health outcomes and enhanced quality of life.

Essential Functions:

• Engage with the enrollee in their homes and other community settings to establish an effective, complex care management relationship, while considering the cultural and linguistic needs of each member.
• Function as a liaison between healthcare providers, community resources, and enrollees to ensure seamless communication and care transitions.
• Perform required assessments on a timely basis, including but not limited to Comprehensive Assessment, MDS-HC (or successor) Functional Assessments, and Crisis and Risk Assessments
• Engage enrollees in care plan development and implementation, providing routine updates as the enrollee's status changes
• Lead the interdisciplinary care team (ICT) and collaborate with peers both internal and external to the organization, to create holistic care plans that address medical and non-medical needs.
• Oversee enrollee utilization of long-term services and supports, ensuring appropriate systems are in place for enrollees to remain in the location of their choice
• Assist members in accessing community resources, including housing, transportation, food assistance, and social services.
• Educate members about their benefits and available services under both Medicare and Medicaid.
• Provide education to members and their families about managing chronic conditions, medication adherence, and preventive care.
• Promote healthy lifestyle choices and self-management strategies.
• Assist enrollees in preventative health strategies, including gap closure
• Follow up with members after hospitalizations or significant health events to ensure continuity of care and prevent readmissions.
• Work closely with primary care physicians, specialists, and other healthcare providers to coordinate care and share relevant information.
• Coordinate with community-based organizations, other stakeholders/entities, state agencies, and other service providers to ensure coordination and avoid duplication of services.
• Advocate for the needs and preferences of enrollees within the healthcare system.
• Evaluate member satisfaction through open communication and monitoring of concerns or issues.
• Regular travel to conduct member, provider and community-based visits as required
• Report abuse, neglect, or exploitation of older adults and adults with disabilities as a mandated reporter as required by State law.
• Adherence to NCQA and Care Management standards
• Perform any other job related duties as requested.

Education and Experience:

• Associates of Science (A.S) 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

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel.
• Understanding of Medicare and Medicaid programs, as well community resources and services available to dual-eligible beneficiaries.
• Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers
• Ability to manage multiple cases and priorities while maintaining attention to detail.
• Adhere to code of ethics that aligns with professional practice.
• Awareness of and sensitivity to the diverse backgrounds and needs of the populations served
• Decision making and problem-solving skills.
• Ability to function independently and effectively as part of an interdisciplinary team
• Strong and effective communication skills, both written and verbal
• Strong interpersonal and customer relations skills
• Strong customer service skills

Licensure and Certification:

• Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN) required
• Case Management Certification is highly preferred
• Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated

To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination