Hybrid RN Clinical Care Manager - Methuen

CareSource Management Services•Lowell, MA

11d•$80,000 - $120,000•Hybrid

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 involves regular travel to members, providers, and community settings, and requires living within commuting distance of Massachusetts and in the assigned territory, subject to possible business-need exceptions. The position is mobile and may require travel for more than 50% of work time. Work may take place in homes, offices, or other public settings, with exposure to typical local weather and periods of standing or sitting. Flexible hours, including possible evenings and weekends, may be required to meet member needs. The role requires use of general office equipment and compliance with applicable care management standards and mandated reporting laws. Compensation is salary-based, with a stated range of $80,000–$120,000. Employees may also qualify for a bonus tied to company and individual performance. Annual influenza vaccination is required for designated positions during influenza season, with a 30-day completion period for employees hired during that season. Employment is conditional on an acceptable driver’s license record check. Reasonable accommodations are available through an interactive review process.

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 work independently and effectively as part of an interdisciplinary team.
Strong written and verbal communication, interpersonal, customer-relations, and customer-service skills.
Valid driver’s license, vehicle, and verifiable insurance; employment is conditional on successful clearance of a driver’s license record check.
Must reside in the assigned territory, subject to possible business-need exceptions, and live within commuting distance of Massachusetts.
Must meet the influenza vaccination requirement for designated positions during influenza season.

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 among healthcare providers, community resources, and enrollees 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 are in place to help enrollees remain in their chosen setting.
Help members access community resources such as 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 prevent readmissions.
Coordinate with primary care physicians, specialists, and other healthcare providers, sharing relevant information.
Coordinate with community-based organizations, stakeholders, state agencies, and service providers to avoid duplication and ensure coordinated services.
Advocate for enrollees’ needs and preferences within the healthcare system.
Evaluate member satisfaction through communication and monitoring of concerns or issues.
Conduct regular 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.