Integrated Care Clinical Manager - Springfield

CareSource • Springfield, MA

20d • $80,000 - $120,000 • 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 engages enrollees in their homes and other community settings, taking cultural and linguistic needs into account. The manager leads interdisciplinary care teams, completes required assessments, develops and updates care plans with enrollees, coordinates transitions and services, and advocates for enrollees’ needs and preferences. The position also includes member and family education, follow-up after hospitalizations or significant health events, and coordination with providers, community organizations, state agencies, and other stakeholders.

This is a mobile position requiring routine travel to member, provider, and community locations; travel may exceed 50% of working time. The employee must live within commuting distance of Massachusetts and in the assigned territory, subject to possible exceptions based on business need. Flexible hours, including possible evenings and weekends, may be needed. Compensation is $80,000–$120,000, with possible performance-based bonus eligibility. 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 license in the Commonwealth of Massachusetts.
• Valid driver's license, vehicle, and verifiable insurance; employment is conditional on acceptable driver’s license record check results.
• 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, interpersonal, customer-relations, and customer-service skills.
• Must reside in the assigned territory, with possible exceptions based on business need, and within commuting distance of Massachusetts.
• Annual proof of 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.
• Ability to travel regularly, potentially more than 50% of working 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 enrollees in their homes and other community settings to establish complex care management relationships while considering cultural and linguistic needs.
• Serve as a liaison between 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.
• 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 appropriate systems support enrollees remaining in their chosen location.
• Help members access housing, transportation, food assistance, social services, and other community resources.
• 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 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 open communication and monitoring concerns or issues.
• Conduct regular member, provider, and community-based visits as required.
• Report suspected abuse, neglect, or exploitation of older adults and adults with disabilities as a mandated reporter under state law.
• Adhere to NCQA and Care Management standards.
• Perform other job-related duties as requested.

Benefits

• Comprehensive total rewards package.
• Potential bonus tied to company and individual performance.
• 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: Mid Level
• Education Level: Associate degree