Integrated Care Clinical Manager - RN - Lynn, MA

CareSource Management Services • Lynn, MA

26d • Onsite

About The Position

The Integrated Care Clinical Manager is a community-based registered nurse responsible for monitoring, follow-up, and clinical care management for 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. The manager engages enrollees in their homes and other community settings, accounting for their cultural and linguistic needs, and serves as a liaison among enrollees, healthcare providers, and community resources.

The position leads interdisciplinary care planning, completes required assessments, oversees use of long-term services and supports, connects members to community resources, and provides education on benefits, chronic conditions, medication adherence, preventive care, and self-management. It coordinates transitions after hospitalizations or other significant health events, advocates for enrollee preferences, monitors satisfaction, and reports abuse, neglect, or exploitation as required by state law. The role adheres to NCQA and Care Management standards and performs other related duties as requested.

This is a mobile, community-based position requiring routine travel to member, provider, and community locations; travel may exceed 50% of work time. The employee must live within commutable distance of Massachusetts and in the assigned territory, subject to possible exceptions for business needs. Flexible hours, including possible evenings and weekends, may be required. The position requires use of general office equipment and may involve exposure to typical local weather and prolonged standing or sitting. Compensation is $80,000–$120,000, with potential eligibility for a performance-based bonus. Annual influenza vaccination is required for designated positions during influenza season as a condition of continued employment.

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, community resources, and services available to dual-eligible beneficiaries.
• Strong interpersonal and communication skills for engaging 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 an acceptable driver's license record check.
• Must reside in the assigned territory; must live within commutable distance of Massachusetts.
• Must complete required influenza vaccination and provide annual proof during the designated influenza season; employees hired during that season have 30 days from hire to complete vaccination and verify the record.

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 among enrollees, healthcare providers, and community resources to support communication and care transitions.
• Complete required assessments promptly, including Comprehensive Assessments, MDS-HC (or successor) Functional Assessments, and Crisis and Risk Assessments.
• Engage enrollees in developing and implementing care plans, updating plans as their 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 appropriate systems support enrollees 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 support continuity of care and help prevent readmissions.
• Coordinate with primary care physicians, specialists, and other healthcare providers and share relevant information.
• Coordinate with community-based organizations, stakeholders, state agencies, and service providers to support coordination and avoid duplication of services.
• Advocate for enrollee 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 as required.
• Report 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

• Potential eligibility for a bonus tied to company and individual performance.
• Substantial and comprehensive total rewards package focused on employee well-being.
• Reasonable accommodations are available to 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