Job Summary
The Clinical Care Manager-Massachusetts at CareSource/Commonwealth Care Alliance 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 improve 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/entities, 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.
- Adherence to NCQA and Care Management standards
- Performs any other job related duties as requested.
Education and Experience
- Associates of Science (A.S) degree in nursing from an accredited nursing program required or
- Master's degree in social work or mental health counseling and independent license required
- 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 of experience working with people with complex medical, behavioral and social needs as an LPN, CHW, 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 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 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 and effective communication skills, both written and verbal
- Strong interpersonal and customer relations skills
- Strong customer service 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 a Licensed Mental Health Counselor (LMHC) required
- Case Management Certification is highly preferred
- Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
- To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of 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. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
- CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions
- This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential.
Will 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 in the same territory they are assigned to work in; exceptions may be considered, due to business need May be required to travel greater than 50% of time to perform work duties. Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members
- Must live within commutable distance to the Commonwealth of Massachusetts
- Over 50% (Mobile) Routine travel required
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.