Hybrid Registered Nurse (RN) Clinical Care Manager - South Holyoke - 5K Sign On Bonus

About the Role

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

Responsibilities

• Engage with enrollees in their homes and other community settings to establish effective, complex care management relationships, considering cultural and linguistic needs.
• Act 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 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 internal and external peers to create holistic care plans addressing medical and non-medical needs.
• Oversee enrollee utilization of long-term services and supports, ensuring systems are in place for enrollees to remain in their preferred location.
• Assist members in accessing community resources, including housing, transportation, food assistance, and social services.
• Educate members about their benefits and available services under Medicare and Medicaid.
• Provide education to members and families about managing chronic conditions, medication adherence, and preventive care.
• Promote healthy lifestyle choices and self-management strategies.
• Assist enrollees in preventive health strategies, including gap closure.
• Follow up with members after hospitalizations or significant health events to ensure continuity of care and prevent readmissions.
• Coordinate care with primary care physicians, specialists, and other healthcare providers.
• Collaborate with community-based organizations, 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.
• Conduct regular travel for member, provider, and community-based visits as required.
• Report abuse, neglect, or exploitation of older adults and adults with disabilities as a mandated reporter.
• Adhere to NCQA and Care Management standards.
• Perform other job-related duties as requested.

Requirements

• Associate of Science (A.S.) degree in nursing from an accredited nursing program.
• Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN).
• Valid driver’s license, vehicle, and verifiable insurance; employment conditional on successful clearance of a driver’s license record check.
• Annual Influenza vaccination required as a condition of continued employment (October 1 – March 31).
• Must reside in the same territory assigned to work in; exceptions may be considered due to business need.
• Must live within commutable distance to the Commonwealth of Massachusetts.
• Case Management Certification highly preferred.

Qualifications

• 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.

Skills

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

Working Conditions

• Mobile position requiring regular travel to homes, offices, or other public settings.
• Exposure to typical weather conditions of the location.
• May require standing or sitting for long periods.
• May require travel greater than 50% of the time to perform work duties.
• Use of general office equipment (telephone, photocopier, fax machine, computer).
• Flexible hours, including possible evenings and/or weekends to meet member needs.

Pay

$80,000 - $120,000. Salary is determined by a combination of education, training, experience, the position’s scope and complexity, discretion and latitude required, and external/internal data.

In addition to base compensation, you may qualify for a bonus tied to company and individual performance.