Clinical Care Manager -RN - Cambridge, MA

CareSource•Cambridge, MA

11d•$90,000 - $120,000•Onsite

About The Position

The Clinical Care Manager is a community-based registered nurse responsible for monitoring, follow-up, and clinical care management for dually eligible enrollees with complex medical, behavioral, and social care needs. The role integrates health services and community resources to coordinate care, improve health outcomes, and enhance quality of life. The position is mobile and requires regular travel to member homes, providers, and community settings across the assigned Massachusetts territory. The Clinical Care Manager establishes effective care management relationships while considering members’ cultural and linguistic needs, completes required assessments, and engages enrollees in developing and updating care plans. The role leads interdisciplinary care teams and coordinates with healthcare providers, community organizations, state agencies, and other stakeholders. It also supports access to long-term services and supports, community resources, and Medicare and Medicaid benefits; provides education on chronic conditions, medication adherence, preventive care, and self-management; and follows up after hospitalizations or significant health events. The position requires a current, unrestricted Massachusetts clinical license as an RN or one of the specified independent behavioral health licenses, along with the stated education and experience qualifications. A valid driver’s license, vehicle, and verifiable insurance are required. Employment is conditional on a satisfactory driver’s license record check. Annual influenza vaccination is required for designated positions during influenza season. The employee must reside within commuting distance of Massachusetts and within the assigned territory, subject to possible business-need exceptions. Travel may exceed 50% of work time; flexible hours, including evenings and/or weekends, may be needed. The listed compensation range is $90,000–$120,000. The position is salaried and may qualify for a bonus tied to company and individual performance. CareSource offers a comprehensive total rewards package, though specific benefits are not listed.

Requirements

Associate of Science degree in nursing from an accredited nursing program, or a master's degree in social work or mental health counseling with an independent license.
Three years of experience as a Registered Nurse or behavioral health clinician, or one year in that capacity plus two years of experience working with people with complex medical, behavioral, and social needs as an LPN, CHW, or MA.
Current unrestricted clinical license in Massachusetts as an RN, LCSW, LICSW, or LMHC.
Valid driver’s license, vehicle, and verifiable insurance; employment is conditional on successful clearance of a driver’s license record check.
Annual proof of influenza vaccination during influenza season for designated positions; employees hired during the season have 30 days from hire to complete vaccination and verify immunization.
Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel.
Understanding of Medicare and Medicaid programs and community resources and services available to dual-eligible beneficiaries.
Strong interpersonal and communication skills for engaging 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 the diverse backgrounds and needs of the populations served.
Decision-making and problem-solving skills.
Ability to work independently and effectively as part of an interdisciplinary team.
Strong written and verbal communication, interpersonal, customer relations, and customer service skills.
Must live within commuting distance of Massachusetts and within the assigned territory, subject to possible business-need exceptions.
Ability to travel regularly; travel may exceed 50% of work time and may involve exposure to typical local weather conditions and prolonged standing and/or sitting.
Ability to use general office equipment, such as a telephone, photocopier, fax machine, and computer.
Flexible hours, including possible evenings and/or weekends, may be required to serve members.

Nice To Haves

Prior experience in care coordination, case management, or working with dual-eligible populations.
Medicaid and/or Medicare managed care experience.
Case Management Certification.

Responsibilities

Engage with enrollees in their homes and other community settings to establish effective care management relationships while considering cultural and linguistic needs.
Liaise among healthcare providers, community resources, and enrollees to support communication and care transitions.
Complete required assessments on time, including Comprehensive Assessments, MDS-HC or successor Functional Assessments, and Crisis and Risk Assessments.
Engage enrollees in developing and implementing care plans, and update plans as their status changes.
Lead interdisciplinary care teams and collaborate with internal and external peers to create holistic plans addressing medical and non-medical needs.
Oversee enrollee use of long-term services and supports and ensure appropriate systems support enrollees remaining in their chosen location.
Help members access community resources, including housing, transportation, food assistance, and social services.
Educate members about Medicare and Medicaid benefits and available services.
Educate members and families about chronic-condition management, medication adherence, and preventive care.
Promote healthy lifestyle choices and self-management strategies.
Assist enrollees with preventive health strategies, including closing care gaps.
Follow up after hospitalizations or significant health events to promote continuity of care and help prevent readmissions.
Coordinate with primary care physicians, specialists, and other healthcare providers and share relevant information.
Coordinate with community-based organizations, stakeholders, state agencies, and other service providers to support coordination and avoid duplicate services.
Advocate for enrollees’ needs and preferences within the healthcare system.
Evaluate member satisfaction through communication and monitoring of concerns or issues.
Travel regularly to conduct member, provider, and community-based visits.
Report abuse, neglect, or exploitation of older adults and adults with disabilities as required of a mandated reporter under state law.
Adhere to NCQA and Care Management standards.
Perform other job-related duties as requested.