Clinical Care Manager Mass General Brigham Health Plan

Brigham and Women's Hospital-posted 2 months ago
$58,656 - $142,448/Yr
Full-time • Mid Level
Hybrid • Braintree, MA
5,001-10,000 employees
Hospitals
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Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. The Clinical Care Manager requires an active RN license and ability to accommodate our hybrid work model requires travel in the area M-F, including practice-based, remote work and enrollee in-person home and community visits. Residing in Eastern, MA area ideally. Clinical Care Managers (3 total) will be geographically aligned, within proximity as member enrollment progresses. Population will primarily include enrollees residing in Essex, Middlesex, Suffolk, Norfolk, Plymouth, Bristol, Dukes, and Nantucket counties. The Clinical Care Manager's responsibilities and caseload may be adjusted based on enrollee enrollment trends.

  • Collaborate with the interdisciplinary care team-including LTSC, GSSC, primary care providers, and specialists-to support program enhancements, process improvements, and comprehensive care coordination.
  • Participate in interdisciplinary care team meetings, ensuring medication reconciliation, timely follow-ups after hospitalization, quality gap closures, and consistent communication with providers and enrollees.
  • Develop, update, and implement individualized, enrollee-centered care plans in collaboration with enrollees and the care team, incorporating self-care, shared decision-making, and addressing behavioral health needs.
  • Conduct outreach, assessments, and home visits using telephonic, electronic, or in-person methods to evaluate clinical status, identify needs, and provide ongoing community-based care management or appropriate referrals.
  • Monitor enrollees' clinical status for early signs of deterioration, proactively intervene to prevent unnecessary hospitalizations, and act as the clinical escalation point for urgent issues through triage, telephonic support, and care coordination.
  • Provide health education, coaching, and routine engagement to assigned enrollees, proactively addressing questions, concerns, and facilitating access to providers and supportive services.
  • Utilize electronic medical record systems to accurately document, monitor, and evaluate enrollee interventions and care plans, ensuring compliance with DSNP regulations and internal policies.
  • Serve as a clinical resource and lead interdisciplinary care team member for assigned enrollees, supporting compliance initiatives, quality assurance, and collaborating with care management leadership on challenging cases.
  • Perform additional duties as assigned by supervisors to support care management goals and promote enrollee well-being.
  • Associate's Degree Nursing required
  • Registered Nurse [RN - State License] required
  • At least 2-3 years experience in health plan or community case management highly preferred
  • Experience with Dual Eligible Populations (Medicare and Medicaid) preferred
  • Bachelor's Degree Nursing preferred
  • Basic Life Support [BLS Certification] preferred
  • Certified Case Management Certification preferred
  • Comprehensive benefits
  • Career advancement opportunities
  • Differentials, premiums and bonuses as applicable
  • Recognition programs designed to celebrate contributions and support professional growth
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