Clinical Care Manager

Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social care needs Engage enrollees in their homes and community settings to establish complex care management relationships Liaise between healthcare providers, community resources, and enrollees to support communication and care transitions Perform comprehensive, functional, crisis, and risk assessments Develop and implement care plans, providing updates as enrollee status changes Lead interdisciplinary care teams and create holistic care plans addressing medical and non-medical needs Oversee utilization of long-term services and supports Help members access housing, transportation, food assistance, and social services Educate members and families about Medicare, Medicaid, chronic conditions, medication adherence, preventive care, and self-management Assist with preventive health strategies and gap closure Follow up after hospitalizations and significant health events to support continuity and prevent readmissions Coordinate care with physicians, specialists, healthcare providers, community organizations, state agencies, and other stakeholders Advocate for enrollee needs and preferences and evaluate member satisfaction Conduct regular member, provider, and community-based visits Report abuse, neglect, or exploitation as a mandated reporter Adhere to NCQA and Care Management standards Perform other job-related duties as requested Requirements Master's degree in social work or mental health counseling and independent license required Ability to independently serve people with complex medical, behavioral, and social needs Prior experience in care coordination, case management, or working with dual-eligible populations preferred Medicaid and/or Medicare managed care experience preferred Clinical field/community-based training is a plus Intermediate proficiency with Microsoft Office, including Outlook, Word, and Excel Understanding of Medicare and Medicaid programs and community resources for dual-eligible beneficiaries Strong interpersonal, written, and verbal communication skills Ability to manage multiple cases and priorities while maintaining attention to detail Adherence to a professional code of ethics Awareness and sensitivity to diverse backgrounds and population needs Decision-making and problem-solving skills Ability to function independently and as part of an interdisciplinary team Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LISCW), or Licensed Mental Health Counselor (LMHC) required Case Management Certification highly preferred Valid driver's license, vehicle, and verifiable insurance required Successful driver's license record check required Influenza vaccination required during designated influenza season Must reside in the assigned territory and within commutable distance to Massachusetts Must be able to travel over 50% of the time / regular travel required Flexible availability, including possible evenings and weekends Core Competencies Demonstrates expertise in care coordination and management for dually eligible populations, with a strong understanding of Medicare and Medicaid programs. Capable of developing and implementing comprehensive care plans while effectively engaging with interdisciplinary teams and community resources. Highest-signal resume keywords Licensed Clinical Social Worker (LCSW) Care Coordination Medicaid Experience Medicare Experience Case Management Certification ATS Optimization Keywords Hard Skills Complex Care Management Crisis Assessment Risk Assessment Care Plan Development Utilization Management Preventive Health Strategies Community Resource Liaison Interdisciplinary Team Leadership Member Advocacy Data Reporting Soft Skills Interpersonal Communication Decision-Making Problem-Solving Attention to Detail Cultural Sensitivity Certifications & Qualifications Licensed Independent Clinical Social Worker (LISCW) Licensed Mental Health Counselor (LMHC) Case Management Certification Industry Keywords Dual-Eligible Populations Healthcare Providers Community-Based Training NCQA Standards Social Services Preventive Care Medication Adherence Continuity of Care Housing Assistance Transportation Services Tools & Technologies Microsoft Office Outlook Word Excel #J-18808-Ljbffr Jobtailor