Clinical Care Manager, Priority Population; TEMP

Well Sense Health Plan is a nonprofit health insurance company serving more than 680,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded more than 25 years ago as Boston Medical Center Health Net Plan, we provide plans and services that work for our members, no matter their circumstances.

It’s an exciting time to join the Well Sense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Clinical Care Manager provides holistic medical care management services for members throughout the continuum of care by assessing the member clinically as well as member’s readiness to make behavioral changes and actively participate in a care plan, establish goals and meet those goals. Well Sense Health Plan members may include those who have chronic conditions and complex care needs, including those considered to be the highest risk members those who are homeless, undergoing organ transplantation, have multiple clinical and behavioral co-morbid conditions, and with special health care needs.

The clinician works collaboratively witha multidisciplinary team (both internal and external) including providers, our clinical vendor partners (behavioral health, pharmacy, etc.) and community/ State agencies to increase patient knowledge, motivation, and compliance with treatment through targeted interventions that address the member’s holistic needs from a medical and psychosocial/socioeconomic standpoint. Following this approach, the goal is to improve member health outcomes and decrease overall cost while improving the member’s overall experience with the health care delivery system.

Utilizing both telephonic outreach and face to face member visits and through the use of assessments, real-time data, motivational interviewing techniques and evidence-based practices, the Clinical Care Manager engages with the member and the multidisciplinary team to develop an Individual Care Plan (ICP) that emphasizes self-management goals, care coordination, psychosocial, socioeconomic, and community-based supports and on-going monitoring and appropriate follow up.

The Clinical Care Manager identifies and addresses barriers to optimal self-management and works with the member, their support persons, and team to coordinate care throughout the health care continuum, assisting the member to access all available benefits and resources including family support and community resources, with a goal of promoting appropriate utilization of services at the appropriate level and site of care such as preventing ambulatory sensitive emergency department visits and inpatient admissions, avoiding readmissions, and encouraging the member to keep scheduled outpatient appointments to include preventive care visits.

The clinical care manager may meet members in their homes, shelters, provider offices, medical facilities, and at locations agreed upon with the member.

Our Investment in You:

Key Functions/Responsibilities:

Completes a targeted general assessment and applicable condition specific assessments.

Evaluates members’ need for complex care management, disease management or chronic condition management.

Collaboratively develops an individual care plan with the member focusing on the member’s goals and objectives, identifying strategies, supports and/or services needed to achieve short and long term goals.

Identifies and addresses barriers to optimal self-management and works with the member and team to coordinate care throughout the health care continuum.

Assists the member to access all available…