Hybrid Registered Nurse (RN) Clinical Care Manager - Medford and surrounding areas

Job Summary Clinical Care Manager - Massachusetts 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 focuses on integrating health services and community resources to coordinate enrollee care for improved health outcomes and enhanced quality of life. Responsibilities Engage with enrollees in their homes and community settings to establish effective care management relationships, respecting cultural and linguistic needs. Act as liaison between healthcare providers, community resources and enrollees to ensure seamless communication and care transitions. Perform timely assessments, including Comprehensive Assessment, MDS-HC (or successor), Functional Assessment, and Crisis & Risk Assessment. Engage enrollees in care plan development and implementation, providing routine updates as status changes. Lead and collaborate with the interdisciplinary care team to create holistic care plans addressing medical and non-medical needs. Oversee enrollee utilization of long-term services and supports, ensuring systems are in place for enrollees to remain in the location of their choice. Assist members in accessing community resources such as housing, transportation, food assistance and social services. Educate members and families about benefits, medication adherence, preventive care and healthy lifestyle choices. Assist with preventive health strategies, including gap closure. Follow up after hospitalizations or significant health events to ensure continuity of care and prevent readmissions. Coordinate with primary care physicians, specialists and other providers to share relevant information. Collaborate with community based organizations, state agencies and other service providers to 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. Travel regularly to conduct member, provider and community visits as required. Report abuse, neglect or exploitation of older adults and adults with disabilities as mandated by state law. Maintain adherence to NCQA and Care Management standards. Perform any other job related duties as requested. Qualifications Associate of Science in Nursing from an accredited program, or a Master’s degree in Social Work or Mental Health Counseling and an independent license. Three (3) years of experience as a Registered Nurse/BH Clinician, or one (1) year as a Registered Nurse/BH Clinician with two (2) years working with people who have complex medical, behavioral and social needs as an LPN, CHW or MA. Prior experience in care coordination, case management or with dual eligible populations preferred. Medicaid and/or Medicare managed care experience preferred. Intermediate proficiency in Microsoft Office (Outlook, Word, Excel). Understanding of Medicare and Medicaid programs and community resources available to dual eligible beneficiaries. Strong interpersonal, communication and customer service skills. Ability to manage multiple cases and priorities while maintaining detail orientation. Decision making and problem solving skills; ability to work independently and as part of an interdisciplinary team. Adherence to code of ethics appropriate to professional practice. Awareness and sensitivity to diverse backgrounds and needs. Licensing and Certification Current unrestricted clinical license in Massachusetts as RN, LCSW, LISCW or LMHC. Case Management Certification highly preferred. Valid driver’s license, vehicle and verifiable insurance required. Influenza vaccination required annually; new hires must provide proof within 30 days during influenza season. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law. Requests are completed through an interactive review process. Working Conditions This is a mobile position with regular travel to different work locations, including homes, offices and public settings. Employees may be exposed to typical weather conditions, required to stand or sit for long periods, and may need to travel more than 50% of the time. Flexible hours, including evenings and weekends, may be required. Compensation Salary range: $90,000 - $120,000. Additional compensation may include a performance based bonus. Total rewards package is comprehensive. Equal Opportunity Statement CareSource is an Equal Opportunity Employer. The company is committed to fostering an inclusive environment that welcomes and supports individuals of all backgrounds. #J-18808-Ljbffr CareSource