RN Clinical Care Manager

• Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social care needs
• Engage enrollees in homes and community settings to establish complex care management relationships
• Liaise between healthcare providers, community resources, and enrollees to ensure communication and care transitions
• Complete comprehensive, functional, crisis, and risk assessments
• Develop, implement, and update enrollee care plans
• Lead interdisciplinary care teams and collaborate with internal and external peers
• Oversee utilization of long-term services and supports
• Assist members with housing, transportation, food assistance, and social services
• Educate members and families about Medicare, Medicaid, chronic conditions, medication adherence, preventive care, benefits, and available services
• Promote healthy lifestyle choices and self-management strategies
• Conduct preventive health strategies and gap closure
• Follow up after hospitalizations and significant health events to support continuity and prevent readmissions
• Coordinate care with physicians, specialists, healthcare providers, community organizations, state agencies, and service providers
• Advocate for enrollee needs and preferences
• Evaluate member satisfaction and monitor concerns
• Conduct regular member, provider, and community-based visits
• Report abuse, neglect, or exploitation as a mandated reporter
• Adhere to NCQA and Care Management standards
• Perform other job-related duties as requested

• Associates of Science (A.S.) degree in nursing from an accredited nursing program required
• Registered Nurse with the ability to independently serve people with complex medical, behavioral, and social needs required
• Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN) required
• Intermediate proficiency with Microsoft Office, including Outlook, Word and Excel
• Understanding of Medicare and Medicaid programs, community resources, and services available to dual-eligible beneficiaries
• Ability to manage multiple cases and priorities while maintaining attention to detail
• Ability to function independently and effectively as part of an interdisciplinary team
• Strong written and verbal communication skills
• Current valid driver's license, vehicle, and verifiable insurance
• Successful driver's license record check required
• Annual Influenza vaccination required during Influenza season
• Must reside in the assigned territory and within commutable distance to the Commonwealth of Massachusetts
• Prior experience in care coordination, case management, or working with dual-eligible populations preferred
• Medicaid and/or Medicare managed care experience preferred
• Clinical Field/Community Based Training a plus
• Case Management Certification highly preferred

Demonstrates expertise in care management for dually eligible enrollees, including comprehensive assessments, care plan development, and interdisciplinary collaboration. Proficient in navigating Medicare and Medicaid programs while advocating for member needs and promoting healthy lifestyle choices.

• Registered Nurse (RN)
• Care Coordination
• Medicare and Medicaid Knowledge
• Case Management Certification
• Interdisciplinary Team Collaboration

• Clinical Care Management
• Crisis Assessment
• Risk Assessment
• Care Plan Development
• Preventive Health Strategies
• Utilization Management
• Community Resource Liaison
• Member Education
• Data Management
• Detail Orientation

• Strong Communication Skills
• Advocacy
• Independent Functioning
• Attention to Detail
• Team Collaboration

• Registered Nurse License
• Case Management Certification
• Annual Influenza Vaccination

• Dually Eligible Enrollees
• Long-Term Services and Supports
• Community-Based Training
• Health Care Transition
• Member Satisfaction Monitoring

• Microsoft Office
• Outlook
• Word
• Excel