Hybrid RN Care Manager - Boston

Job Summary

The Integrated Care Clinical Manager - Massachusetts is a community-based registered nurse responsible for monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on integrating health services and community resources to coordinate enrollee care, improving health outcomes and enhancing quality of life.

• Engage with the enrollee in their homes and other community settings to establish an effective, complex care management relationship, while considering cultural and linguistic needs.
• Function as a liaison between healthcare providers, community resources and enrollees to ensure seamless communication and care transitions.
• Perform required assessments on a timely basis, including but not limited to Comprehensive Assessment, MDS-HC (or successor) Functional Assessments and Crisis and Risk Assessments.
• Engage enrollees in care plan development and implementation, providing routine updates as enrollee status changes.
• Lead the interdisciplinary care team (ICT) and collaborate with internal and external peers to create holistic care plans addressing medical and non-medical needs.
• Oversee enrollee utilisation of long-term services and supports, ensuring appropriate systems are in place for enrollees to remain in their preferred location.
• Assist members in accessing community resources, including housing, transportation, food assistance and social services.
• Educate members about their benefits and available services under Medicare and Medicaid.
• Provide education to members and families about chronic condition management, medication adherence and preventive care.
• Promote healthy lifestyle choices and self-management strategies.
• Assist enrollees in preventative health strategies, including gap closure.
• Follow up with members after hospitalisations or significant health events to ensure continuity of care and prevent readmissions.
• Work closely with primary care physicians, specialists and other healthcare providers to coordinate care and share relevant information.
• Coordinate with community-based organisations, state agencies and other service providers to avoid duplication of services.
• Advocate for the needs and preferences of enrollees within the healthcare system.
• Evaluate member satisfaction through open communication and monitoring of concerns or issues.
• Travel regularly to conduct member, provider and community visits as required.
• Report abuse, neglect or exploitation of older adults and adults with disabilities as mandated by state law.
• Adhere to NCQA and Care Management standards.
• Perform any other job-related duties as requested.

• Associate of Science (A.S.) degree in nursing from an accredited nursing program.
• Registered Nurse with the ability to independently serve individuals with complex medical, behavioural and social needs.
• Prior experience in care coordination, case management or working with dual-eligible populations is preferred.
• Medicaid and/or Medicare managed-care experience is preferred.
• Clinical field or community-based training is a plus.

• Intermediate proficiency with Microsoft Office (Outlook, Word, Excel).
• Understanding of Medicare, Medicaid and community resources for dual-eligible beneficiaries.
• Strong interpersonal and communication skills for engaging members, families and healthcare providers.
• Ability to manage multiple cases and priorities while maintaining attention to detail.
• Adherence to code of ethics aligning with professional practice.
• Awareness of and sensitivity to diverse backgrounds and needs.
• Decision-making and problem-solving skills.
• Ability to function independently and as part of an interdisciplinary team.
• Strong written and verbal communication skills.
• Strong customer service and customer-relation skills.

• Current unrestricted clinical licence in Massachusetts as a Registered Nurse (RN) required.
• Case Management Certification is highly preferred.
• Must have a valid driver’s licence, vehicle and verifiable insurance.
• Employment is conditional on a successful driver’s licence record…