Hybrid RN Case Manager - South Shore / Southeast MA - $5K SIGN ON BONUS!

CareSource Management Services•Quincy, MA

1d•Hybrid

About The Position

The Integrated Care Clinical Manager – Massachusetts 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 needs. The role integrates health services and community resources to coordinate care, improve health outcomes, and enhance quality of life. It is a mobile position requiring regular travel to members, providers, and community locations, with more than 50% travel possible. The employee must reside in the assigned territory and within commuting distance of Massachusetts. Flexible hours, including possible evenings and weekends, may be needed to serve members. The position requires an Associate of Science degree in nursing from an accredited program and a current, unrestricted Massachusetts Registered Nurse license. Candidates must have a valid driver’s license, a vehicle, and verifiable insurance, and must pass a driver’s license record check. Annual influenza vaccination is required for designated positions during influenza season. A case management certification is highly preferred; prior care coordination, case management, dual-eligible population, Medicare or Medicaid managed-care experience, and clinical field or community-based training are preferred or advantageous. The role involves working independently and as part of an interdisciplinary team; engaging members and families with cultural and linguistic sensitivity; coordinating with healthcare providers, community organizations, state agencies, and other stakeholders; and supporting members’ access to care and community resources. The employee must adhere to applicable care management standards, professional ethics, and mandated reporting requirements. Compensation is a salary of $80,000–$120,000, with possible additional performance-based bonus. The position offers a comprehensive total rewards package. A $5,000 sign-on bonus is stated in the job title.

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.
Valid driver’s license, vehicle, and verifiable insurance; employment is conditional on an acceptable driver’s license record check.
Annual proof of influenza vaccination for designated positions during influenza season (October 1–March 31); employees hired during the season have 30 days from hire to complete vaccination and verification.
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.
Ability to adhere 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.
Strong interpersonal, customer relations, and customer service skills.
Must reside in the assigned territory; exceptions may be considered based on business need.
Must live within commuting distance of the Commonwealth of Massachusetts.
Able to travel regularly and potentially more than 50% of the time, and to work flexible hours, including possible evenings and weekends as needed.

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 with enrollees in their homes and other community settings to establish effective complex care management relationships, considering cultural and linguistic needs.
Serve as a liaison between healthcare providers, community resources, and enrollees 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.
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 develop 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 locations.
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 with members after hospitalizations or 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, other stakeholders and entities, state agencies, and service providers to support coordination and avoid duplicated 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 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.