Hybrid RN Clinical Care Manager - Methuen

CareSource•Lowell, MA

12d•$80,000 - $120,000•Hybrid

About The Position

The Integrated Care Clinical Manager is a community-based registered nurse who provides monitoring, follow-up, and clinical care management to 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 manager engages with enrollees in their homes and other community settings, taking account of cultural and linguistic needs, and leads an interdisciplinary care team in developing holistic care plans. This is a mobile position requiring routine travel to member, provider, and community locations. The employee must live within commutable distance of Massachusetts and in the assigned territory, unless an exception is considered for business need. Travel may exceed 50% of working time. Flexible hours, including possible evenings and weekends, may be needed to serve members. The position may involve exposure to typical local weather and standing or sitting for long periods, and requires use of general office equipment. The listed compensation range is $80,000–$120,000 in salary. The role may also qualify for a bonus tied to company and individual performance, and includes a comprehensive total rewards package.

Requirements

Associate of Science degree in nursing from an accredited nursing program.
Registered Nurse able to independently serve people with complex medical, behavioral, and social needs.
Current unrestricted Massachusetts Registered Nurse license.
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 to engage effectively 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 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.
Valid driver’s license, vehicle, and verifiable insurance; employment is conditional on acceptable driver’s license record check results.
Annual influenza vaccination during the October 1–March 31 influenza season is required for designated positions; employees hired during the season have 30 days from hire to complete vaccination and verify immunization.
Must reside in the assigned territory, subject to possible business-need exceptions, and within commutable distance of Massachusetts.
Ability to meet the mobile role’s travel requirements, which may exceed 50% of working time.

Nice To Haves

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

Responsibilities

Engage with enrollees in homes and other community settings to establish complex care management relationships while considering cultural and linguistic needs.
Coordinate communication and care transitions among enrollees, healthcare providers, and community resources.
Complete required assessments in a timely manner, including Comprehensive Assessment, 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 the interdisciplinary care team 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 in remaining in the location of their choice.
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 and significant health events to support continuity of care and prevent readmissions.
Coordinate care and share relevant information with primary care physicians, specialists, and other healthcare providers.
Coordinate with community-based organizations, stakeholders, state agencies, and service providers to support coordinated care and avoid duplication of services.
Advocate for enrollees’ needs and preferences within the healthcare system.
Evaluate member satisfaction through communication and monitoring concerns or issues.
Travel regularly for member, provider, and community-based visits as required.
Report suspected 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.