Hybrid Registered Nurse (RN) Clinical Care Manager - Ipswitch - 5k Sign on Bonus

Job Summary: The Integrated Care Clinical Manager - Massachusetts is a community-based registered nurse responsible for providing monitoring, follow-up, and clinical care management to dually-eligible enrollees with complex medical, behavioral, and social care needs. This position focuses on integrating health services and community resources to coordinate enrollee care for improved health outcomes and enhanced quality of life. Essential Functions Engage with the enrollee in their homes and other community settings to establish an effective complex care management relationship, while considering cultural and linguistic needs. Function as a liaison between healthcare providers, community resources, and enrollees to ensure seamless communication and care transitions. Perform required assessments on a timely basis, including but not limited to Comprehensive Assessment, MDS-HC or successor functional assessments, and crisis and risk assessments. Engage enrollees in care plan development and implementation, providing routine updates as the enrollee’s status changes. Lead the interdisciplinary care team and collaborate with peers both internal and external to the organization to create holistic care plans that address medical and non-medical needs. Oversee enrollee utilization of long-term services and supports, ensuring appropriate systems are in place for enrollees to remain in the location of their choice. Assist members in accessing community resources, including housing, transportation, food assistance, and social services. Educate members about their benefits and available services under both Medicare and Medicaid. Provide education to members and their families about managing chronic conditions, medication adherence, and preventive care. Promote healthy lifestyle choices and self-management strategies. Assist enrollees in preventative health strategies, including gap closure. Follow up with members after hospitalizations or significant health events to ensure continuity of care and prevent readmissions. Work closely with primary care physicians, specialists, and other healthcare providers to coordinate care and share relevant information. Coordinate with community-based organizations, other stakeholders and state agencies, and other service providers to ensure coordination and avoid duplication of services. Advocate for the needs and preferences of enrollees within the healthcare system. Evaluate member satisfaction through open communication and monitoring of concerns or issues. Regularly travel 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 as required by State law. Adhere to NCQA and Care Management standards. Perform any other job-related duties as requested. Education and Experience Associate of Science (A.S) degree in nursing from an accredited nursing program required. Registered Nurse with the ability to independently serve people with complex medical, behavioral, and social needs required. Prior experience in care coordination, case management, or working with dual-eligible populations preferred. Medicaid and/or Medicare managed care experience preferred. Clinical field or community-based training preferred. Competencies, Knowledge and Skills Intermediate proficiency with Microsoft Office (Outlook, Word, Excel). Understanding of Medicare and Medicaid programs and community resources and services available to dual-eligible beneficiaries. Strong interpersonal and communication skills to engage with members, families, and healthcare providers. Ability to manage multiple cases and priorities while maintaining attention to detail. Adherence to a code of ethics that aligns 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. Strong interpersonal and customer relations skills. Strong customer service skills. Licensure and Certification Current unrestricted clinical license in Massachusetts as an RN required. Case Management Certification highly preferred. Must have a valid driver’s license, vehicle, and verifiable insurance. Employment contingent upon successful clearance of a driver’s license record check; if results are unacceptable, the offer may be withdrawn or employment terminated. Influenza vaccination: annual proof required for designated positions during the influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during the season have 30 days to complete the vaccination and provide verification. Travel and Working Conditions Mobile position: regular travel to different work locations, including homes, offices, or other public settings, essential. Exposure to weather conditions typical of the location and may require standing and/or sitting for long periods. Must reside in the same territory assigned to work; may be required to travel greater than 50% of the time. Must live within commutable distance to the Commonwealth of Massachusetts. Use general office equipment such as telephone, photocopier, fax machine, and computer. Flexible hours, including possible evenings and/or weekends, as needed to serve members. Compensation Compensation Range: $80,000 – $120,000. Salary is based on education, training, experience, scope and complexity of the role, discretion and latitude required, and other internal and external data. In addition, compensation may include a bonus tied to company and individual performance. Total rewards package includes a comprehensive benefits program. Equal Opportunity Employer CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. CareSource reserves the right to amend this job description at any time. #J-18808-Ljbffr CareSource