RN Care Manager

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

📋 Description

• Engage with enrollees in their homes and community settings to build complex care management relationships.

• Monitor, follow up, and provide clinical care management for dually eligible enrollees with intricate medical, behavioral, and social needs.

• Integrate health services and community resources to coordinate care and enhance outcomes.

• Serve as a liaison between healthcare providers, community resources, and enrollees.

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

• Formulate and implement care plans with enrollees, updating them as statuses change.

• Lead interdisciplinary care teams and collaborate with both internal and external colleagues.

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

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

• Educate members about Medicare and Medicaid benefits and available services.

• Inform members and families about chronic conditions, medication adherence, preventive care, healthy lifestyles, and self-management strategies.

• Promote preventive health strategies and facilitate gap closure.

• Follow up after hospitalizations and significant health events to ensure continuity of care and prevent readmissions.

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

• Advocate for the needs and preferences of enrollees.

• Assess member satisfaction and address concerns.

• Conduct regular visits to members, providers, and community-based organizations.

• Report any instances of abuse, neglect, or exploitation as a mandated reporter.

• Comply with NCQA and care management standards.

• Undertake other job-related duties as assigned.

⛳️ Requirements

• An Associate of Science (A.S.) degree in nursing from an accredited nursing program is required, or a Master's degree in social work or mental health counseling with an independent license is necessary.

• A minimum of 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 individuals with complex medical, behavioral, and social needs as an LPN, CHW, or MA.

• Current unrestricted clinical license in the Commonwealth of Massachusetts as an RN, LCSW, LICSW, or LMHC is required.

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

• A solid understanding of Medicare and Medicaid programs and community resources for dual-eligible beneficiaries.

• Exceptional written and verbal communication, interpersonal, customer relations, and customer service skills.

• Ability to manage multiple cases and priorities while paying attention to detail.

• Capability to work independently as well as collaboratively within an interdisciplinary team.

• Awareness and sensitivity to diverse backgrounds and needs.

• Strong decision-making and problem-solving abilities.

• Must possess a valid driver's license, vehicle, and verifiable insurance.

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

• Annual Influenza vaccination is mandatory during the Influenza season.

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

• Willingness to travel more than 50% of the time.

🏝️ Benefits

• A bonus linked to company and individual performance may be available.

• A comprehensive total rewards package.

• Reasonable accommodations for qualified individuals.

• Flexible hours, including potential evenings and/or weekends.

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