Registered Nurse Care Manager

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Deliver monitoring, follow-up, and clinical care management for dually eligible enrollees facing complex medical, behavioral, and social care challenges.

• Engage with enrollees within their homes and community environments to build robust complex care management relationships.

• Act as a liaison among healthcare providers, community resources, and enrollees to streamline communication and facilitate care transitions.

• Conduct Comprehensive, MDS-HC or successor Functional, Crisis, and Risk Assessments.

• Collaborate with enrollees to develop and implement care plans, providing updates as their circumstances evolve.

• Lead interdisciplinary care teams to create integrated plans addressing both medical and non-medical needs.

• Supervise the utilization of long-term services and supports.

• Assist members with needs related to housing, transportation, food assistance, and social services.

• Educate members and their families about Medicare, Medicaid, chronic conditions, medication adherence, preventive care, healthy lifestyles, and self-management techniques.

• Promote preventive health strategies and address care gaps.

• Follow up post-hospitalizations and after critical health events to ensure continuity of care and minimize readmissions.

• Coordinate efforts with physicians, specialists, healthcare providers, community organizations, state agencies, and service providers.

• Advocate for the needs and preferences of enrollees.

• Assess member satisfaction and monitor any concerns.

• Conduct regular visits to members, providers, and community-based organizations, with travel potentially exceeding 50% of working hours.

• Report any instances of abuse, neglect, or exploitation as a mandated reporter in accordance with state law.

• Comply with NCQA and Care Management standards.

• Perform additional related duties as requested.

⛳️ Requirements

• An Associate of Science (A.S.) degree in nursing from an accredited program is required.

• Registered Nurse capable of independently serving individuals with complex medical, behavioral, and social needs is required.

• A current unrestricted clinical license as a Registered Nurse (RN) in the Commonwealth of Massachusetts is mandatory.

• Intermediate proficiency in Microsoft Office, including Outlook, Word, and Excel.

• Familiarity with Medicare and Medicaid programs and community resources available to dual-eligible beneficiaries.

• Strong interpersonal and communication abilities.

• Capacity to manage multiple cases and priorities while maintaining a keen attention to detail.

• Ability to function independently as well as collaboratively within an interdisciplinary team.

• A valid driver's license, vehicle, and verifiable insurance are required.

• Successful completion of a driver's license record check.

• An annual Influenza vaccination is required during the Influenza season, along with proof of vaccination.

• Must reside within the assigned territory and be within a commutable distance to the Commonwealth of Massachusetts.

• Previous experience in care coordination, case management, or working with dual-eligible populations is preferred.

• Experience with Medicaid and/or Medicare managed care is preferred.

• Clinical Field/Community Based Training is advantageous.

• Case Management Certification is highly preferred.

🏝️ Benefits

• A sign-on bonus of $5,000.

• Potential bonuses tied to individual and company performance.

• A comprehensive total rewards package.

• Reasonable accommodations for qualified individuals.

• Flexible working hours, including possible evenings and/or weekends as needed.

• Mobile work arrangement with regular travel to homes, offices, and public settings.