Integrated Care Clinical Manager -Lowell

CareSource Management Services•Lowell, MA

5d•Onsite

About The Position

The Integrated Care Clinical Manager is a community-based registered nurse who provides 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 manager engages enrollees in their homes and other community settings, taking their cultural and linguistic needs into account, and serves as a liaison among enrollees, healthcare providers, and community resources. The position leads interdisciplinary care planning and coordinates medical and non-medical services, including long-term services and supports. It includes assessing enrollee needs, developing and updating care plans, supporting access to community resources and benefits, providing education on chronic conditions and preventive care, and following up after hospitalizations or significant health events. The manager advocates for enrollee preferences, monitors satisfaction and concerns, and reports suspected abuse, neglect, or exploitation as required by state law. The role requires regular community travel and adherence to applicable NCQA and care management standards. This is a mobile role based in Massachusetts. Regular travel to homes, offices, and other public settings is essential and may exceed 50% of work time. Flexible hours, including possible evenings and weekends, may be needed to serve members. The employee must live within commutable distance of Massachusetts and in the assigned territory, subject to possible business-need exceptions. Compensation is $75,200–$120,500, with possible performance-based bonus eligibility. The position requires annual influenza vaccination during the designated influenza season, subject to applicable accommodation processes.

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 Registered Nurse license in the Commonwealth of Massachusetts.
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 skills, interpersonal and customer relations skills, and customer service skills.
Valid driver’s license, vehicle, and verifiable insurance; employment is conditional on acceptable driver’s license record-check results.
Annual proof of influenza vaccination during influenza season for designated positions, subject to applicable accommodation processes.
Must reside within commutable distance of Massachusetts and in the assigned territory, with possible exceptions based on business need.
Ability to meet the role’s mobile-work requirements, including regular travel that may exceed 50% of work time.

Nice To Haves

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

Responsibilities

Engage enrollees in their homes and other community settings to establish complex care management relationships while considering cultural and linguistic needs.
Act as a liaison among healthcare providers, community resources, and enrollees to support communication and care transitions.
Complete required assessments on time, including Comprehensive, MDS-HC (or successor) Functional, and Crisis and Risk Assessments.
Engage enrollees in developing and implementing care plans, and update plans as enrollee status changes.
Lead the interdisciplinary care team 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 systems support remaining in the enrollee’s chosen location.
Help members access community resources such as 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 support continuity of care and help prevent readmissions.
Coordinate with primary care physicians, specialists, and other healthcare providers, sharing relevant information.
Coordinate with community-based organizations, stakeholders, state agencies, and service providers to support coordination 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 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.