Registered Nurse (RN) Clinical Care Manager

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

📋 Description

• Deliver monitoring, follow-up, and clinical care management to dually eligible individuals facing intricate medical, behavioral, and social care challenges.

• Connect with enrollees in their residences and community environments to build complex care management relationships.

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

• Conduct thorough functional, crisis, and risk assessments.

• Create and execute care plans in collaboration with enrollees and provide updates as circumstances evolve.

• Lead interdisciplinary care teams and formulate holistic care plans that address both medical and non-medical requirements.

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

• Assist members in accessing housing, transportation, food assistance, and social services.

• Educate members about Medicare, Medicaid, benefits, chronic condition management, medication adherence, and preventive care.

• Encourage healthy lifestyle choices and self-management techniques.

• Support preventive health initiatives and address care gaps.

• Follow up post-hospitalization and after significant health incidents to ensure continuity and reduce readmissions.

• Coordinate care with primary care physicians, specialists, healthcare providers, community organizations, state agencies, and other stakeholders.

• Advocate for the needs and preferences of enrollees.

• Assess member satisfaction and monitor any concerns.

• Conduct regular visits to members, providers, and community resources, 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 other related tasks as assigned.

⛳️ Requirements

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

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

• Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN) is required.

• Valid driver's license, vehicle, and verifiable insurance are essential.

• Successful clearance of a driver's license record check is necessary.

• Annual proof of Influenza vaccination during the Influenza season (October 1–March 31) is required.

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

• Knowledge of Medicare and Medicaid programs and community resources for dual-eligible beneficiaries.

• Excellent interpersonal and communication skills.

• Capability to manage multiple cases and priorities while ensuring attention to detail.

• Commitment to a professional code of ethics.

• Ability to work independently as well as collaborate within an interdisciplinary team.

• Strong customer relations and customer service abilities.

• Must reside within the designated territory.

• Should live within a commutable distance to the Commonwealth of Massachusetts.

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

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

• Clinical Field/Community-Based Training is a plus.

• Case Management Certification is highly preferred.

🏝️ Benefits

• Bonus linked to company and individual performance may be available.

• Comprehensive total rewards package offered.

• Reasonable accommodations for disabilities, medical conditions, and sincerely held religious beliefs are provided.

• Annual Influenza vaccination is administered as a condition of continued employment.

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

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