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

Hybrid Registered Nurse (RN) Clinical Care Manager - Malden and surrounding areas Boston, MA | Full time Posted 6 Days Ago | Requisition ID: R12946 Job Summary The Clinical Care 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. The role 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 the cultural and linguistic needs of each member. 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 (ICT) 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, 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. Regular 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. Master’s degree in social work or mental health counseling and an independent license required. Three (3) years of experience as a Registered Nurse/BH Clinician. One (1) year as a Registered Nurse/BH Clinician with two (2) years of experience working with people with complex medical, behavioral, and social needs as an LPN, CHW, or MA required. Prior experience in care coordination, case management, or working with dual‑eligible populations preferred. Medicaid and/or Medicare managed care experience preferred. Competencies, Knowledge and Skills Intermediate proficiency level with Microsoft Office, including Outlook, Word, and Excel. Understanding of Medicare and Medicaid programs, as well as community resources and services available to dual‑eligible beneficiaries. Strong interpersonal and communication skills to effectively engage with members, families, and healthcare providers. Ability to manage multiple cases and priorities while maintaining attention to detail. Adhere 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 customer service and relational skills. Licensure and Certification Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LISCW), or Licensed Mental Health Counselor (LMHC) required. Case Management Certification is highly preferred. Must have a valid driver’s license, vehicle, and verifiable insurance. Employment is conditional pending a successful clearance of a driver’s license record check. Influenza vaccination is required for this position. CareSource requires annual proof of influenza vaccination for designated positions during influenza season (October 1 – March 31) as a condition of continued employment. CareSource adheres to all federal, state, and local regulations and provides reasonable accommodations to qualified individuals with disabilities or medical conditions. Working Conditions This is a mobile position; regular travel to different work locations, including homes, offices, or other public settings, is essential. Employees may be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time. Must reside within a commutable distance to the Commonwealth of Massachusetts. Over 50% routine travel required. Flexible hours, including possible evenings and/or weekends, may be required to serve the needs of members. Compensation Range $90,000 – $120,000 In addition to base compensation, employees may qualify for a bonus tied to company and individual performance. CareSource also offers a comprehensive total rewards package. Compensation Type Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #J-18808-Ljbffr Commonwealth Care Alliance Inc