Hybrid RN Care Manager - Metro West / Central MA - $5K SIGN ON BONUS! - R13250-6

Commonwealth Care Alliance® (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs, delivering comprehensive, integrated, and person-centered care.

About the role

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 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.
• 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 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 appropriate 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.
• 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 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.
• Travel regularly 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.
• Influenza vaccination required annually (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.
• 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.

Schedule

• Flexible hours, including possible evenings and/or weekends as needed to serve members.
• Over 50% mobile; routine travel required.
• May be required to travel greater than 50% of the time to perform work duties.

Pay

Compensation Range: $80,000 - $120,000. CareSource takes into consideration a candidate’s education, training, and experience, as well as the position’s scope and complexity, when establishing salary. In addition to base compensation, you may qualify for a bonus tied to company and individual performance.

Benefits

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