Integrated Care Clinical Manager -Lowell

CareSource • Somerville, MA

8d • $75,200 - $120,500 • Onsite

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 position integrates health services and community resources to coordinate care, improve health outcomes, and enhance quality of life. The role involves in-person visits in homes and other community settings, regular travel, and flexible hours that may include evenings or weekends to meet member needs. The employee must reside within the assigned territory, live within commutable distance of Massachusetts, and may be required to travel more than 50% of the time.

The manager leads interdisciplinary care teams and collaborates with enrollees, families, healthcare providers, community organizations, state agencies, and other service providers. The role includes completing assessments, developing and updating care plans, coordinating long-term services and supports and transitions of care, helping members access community resources, and educating members about benefits, chronic conditions, medication adherence, preventive care, and self-management. The employee also advocates for enrollee preferences, monitors satisfaction, reports suspected abuse, neglect, or exploitation as a mandated reporter, and adheres to NCQA and care management standards.

This is a mobile position requiring use of general office equipment and exposure to typical local weather conditions. The employee may need to stand or sit for extended periods. Compensation is $75,200–$120,500, with potential eligibility for a performance-based bonus and a comprehensive total rewards package. A current Massachusetts RN license, valid driver's license, vehicle, and verifiable insurance are required. Annual influenza vaccination is required for designated positions during influenza season.

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 clinical 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.
• Strong interpersonal, customer relations, and customer service skills.
• 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; employees hired during the season have 30 days from hire to complete vaccination and verify immunization.
• Must reside in the assigned territory, with exceptions potentially considered based on business need.
• Must live within commutable distance of the Commonwealth of Massachusetts.
• Ability to travel regularly and potentially more than 50% of the time.
• Ability to use general office equipment, including a telephone, photocopier, fax machine, and computer.
• Ability to stand and/or sit for long periods and work in typical local weather conditions.

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 homes and community settings to establish complex 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 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 enrollee 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 in 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 gap closure.
• Follow up 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, stakeholders, state agencies, and service providers to coordinate services and avoid duplication.
• Advocate for enrollee 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 abuse, neglect, or exploitation of older adults and adults with disabilities as required by state law.
• Adhere to NCQA and care management standards.
• Perform other job-related duties as requested.

Benefits

• Potential eligibility for a bonus tied to company and individual performance.
• Substantial and comprehensive total rewards package focused on employee well-being.
• Reasonable accommodations for qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree