Integrated Care Clinical Manager - Springfield

CareSource Management Services • Springfield, MA

19d • 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 role integrates health services and community resources to coordinate care, improve health outcomes, and enhance quality of life. The position is mobile, requires regular travel to member, provider, and community locations, and requires residence within the assigned territory and commutable distance to Massachusetts.

The manager engages enrollees in homes and other community settings, taking cultural and linguistic needs into account. They coordinate with healthcare providers, community organizations, state agencies, and other service providers; lead interdisciplinary care teams; develop and update holistic care plans; support access to long-term services and community resources; and educate enrollees and families about benefits, chronic conditions, medications, preventive care, and self-management. The role also includes follow-up after hospitalizations and significant health events, advocacy, satisfaction monitoring, required assessments, and mandated reporting of abuse, neglect, or exploitation.

The role requires an associate degree in nursing, an unrestricted Massachusetts RN license, and the ability to independently serve people with complex needs. Prior care coordination, case management, or dual-eligible population experience and case management certification are preferred. Compensation is $80,000–$120,000, with possible performance-based bonus eligibility and a comprehensive total rewards package.

Requirements

• Associate of Science degree in nursing from an accredited nursing program.
• Current unrestricted Registered Nurse license in the Commonwealth of Massachusetts.
• Ability to independently serve people with complex medical, behavioral, and social needs.
• 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 function 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.
• Influenza vaccination is required for designated positions during influenza season (October 1–March 31), with required proof; employees hired during the season have 30 days from hire to complete vaccination and verification.
• Must reside in the assigned territory; exceptions may be considered based on business need.
• Must live within commutable distance to the Commonwealth of Massachusetts.
• Ability to meet the position’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.
• 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 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 care plan development and implementation, 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 appropriate systems support enrollees in remaining in their chosen location.
• 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 lifestyles and self-management.
• Assist enrollees with preventive health strategies, including closing care gaps.
• Follow up after hospitalizations or significant health events to promote continuity of care and prevent readmissions.
• Coordinate with primary care physicians, specialists, and other healthcare providers to share relevant information and coordinate care.
• Coordinate with community-based organizations, stakeholders, state agencies, and service providers to support coordination and avoid duplication.
• Advocate for enrollees’ needs and preferences within the healthcare system.
• Evaluate member satisfaction through communication and monitoring of 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

• Possible bonus tied to company and individual performance.
• Substantial and comprehensive total rewards package.
• 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