Clinical Care Manager -RN - Cambridge, MA

CareSource Management Services•Cambridge, MA

11d•Onsite

About The Position

The Clinical Care Manager-Massachusetts is a community-based clinical professional responsible for monitoring, follow-up, and clinical care management for dually eligible enrollees with complex medical, behavioral, and social care needs. The position integrates health services and community resources to coordinate care, improve health outcomes, and enhance quality of life. The manager engages enrollees in their homes and other community settings, taking cultural and linguistic needs into account, and serves as a liaison among enrollees, healthcare providers, and community resources. The role includes conducting required assessments, developing and updating care plans with enrollees, leading interdisciplinary care teams, overseeing the use of long-term services and supports, and helping enrollees access community resources and understand their Medicare and Medicaid benefits. The Clinical Care Manager provides education on chronic condition management, medication adherence, preventive care, and healthy lifestyle strategies; coordinates follow-up after hospitalizations and significant health events; advocates for enrollee needs and preferences; and monitors satisfaction and concerns. The role also requires mandated reporting of abuse, neglect, or exploitation and adherence to NCQA and care management standards. This is a mobile position involving routine travel to member, provider, and community locations, potentially exceeding 50% of work time. The employee must reside in the assigned territory, live within commuting distance of Massachusetts, and may need to work flexible hours, including evenings or weekends. Compensation is a salary of $90,000–$120,000, with potential eligibility for a performance-based bonus. Employment is conditional on acceptable driver-record clearance. Annual influenza vaccination is required for designated positions during influenza season.

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.
Either three years of experience as a Registered Nurse or behavioral health clinician, or one year in that role plus two years of experience working with people with complex medical, behavioral, and social needs as an LPN, CHW, or MA.
Current unrestricted Massachusetts clinical license as an RN, LCSW, LICSW, or LMHC.
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, communication, customer relations, and customer service skills.
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.
Valid driver's license, vehicle, and verifiable insurance.
Successful driver’s license record check; unacceptable results may result in withdrawal of the offer or termination from the position.
Must reside in the assigned territory, subject to possible exceptions based on business need, and live within commuting distance of Massachusetts.
Annual proof of influenza vaccination is required for designated positions during influenza season; employees hired during that season have 30 days from hire to complete vaccination and verify immunization.

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 enrollees in their homes and community settings to establish effective care management relationships while considering cultural and linguistic needs.
Serve as a liaison among enrollees, healthcare providers, and community resources to support communication and care transitions.
Complete required assessments in a timely manner, including Comprehensive Assessments, MDS-HC or successor Functional Assessments, and Crisis and Risk Assessments.
Involve 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 care plans addressing medical and non-medical needs.
Oversee enrollee use of long-term services and supports and ensure systems support enrollees remaining in their chosen location.
Help members access housing, transportation, food assistance, social services, and other community resources.
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 and significant health events to support continuity of care and prevent readmissions.
Coordinate with primary care physicians, specialists, and other healthcare providers and share relevant information.
Coordinate with community organizations, stakeholders, state agencies, and service providers to avoid duplication and ensure coordinated 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.