Hybrid RN Care Clinical Manager

This is a community-based registered nurse role focused on integrating health services and community resources to coordinate care for dually-eligible enrollees with complex medical, behavioral, and social needs in Massachusetts.

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.
• Work closely with primary care physicians, specialists, and other healthcare providers to coordinate care and share relevant information.
• Coordinate 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.
• 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.
• 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.
• 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.
• Annual Influenza vaccination required (October 1 – March 31) as a condition of continued employment.

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.
• Case Management Certification highly preferred.

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 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 weather conditions typical of the location.
• May require standing or sitting for long periods.
• Flexible hours, including possible evenings and/or weekends to serve member needs.
• Routine travel required; may exceed 50% of time.
• Use of general office equipment (telephone, photocopier, fax, computer).

Pay

$80,000 - $120,000 annually. Salary considers a candidate’s education, training, experience, the position’s scope and complexity, discretion required, and external/internal data. Bonus eligibility tied to company and individual performance.

Benefits

CareSource offers a substantial and comprehensive total rewards package focused on employee well-being.